


Vol 10, No 8 (2024)
ORIGINAL STUDIES
Correlation between estrogen deficiency and non-alcoholic fatty liver disease in female patients
Abstract
Abstract. In recent years, the role of hypoestrogenemia as an independent risk factor for the development and progression of non-alcoholic fatty liver disease (NAFLD) has been actively discussed, but this correlation has been poorly studied.
The aim: to study the frequency and severity of liver steatosis in female patients with premature ovarian failure (POF).
Material and methods. The study included 86 non-obese female patients aged 29–40 years, who were divided into three groups: group 1 (control, n = 40) – females with a regular menstrual cycle (MC) and normal levels of follicle-stimulating hormone (FSH) and estradiol; group 2 (n = 29) – females who had not had menstruation for more than 3 months and had an increased FSH level; group 3 (n = 17) – females with premature menopause (PM). On days 3–5 of the menstrual cycle, blood sampling was taken and the following parameters were assessed: FSH, estradiol, glucose, insulin, triglycerides, low- and high-density lipoproteins, total cholesterol, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase. Waist circumference (WC) was measured, body mass index, HOMA-IR index, and liver steatosis coefficient FLI (Fatty Liver Index) were calculated, and an ultrasound examination (US) of liver was performed.
Results. As estrogen deficiency increased, the examined females showed a significant increase in WC (p = 0.001). Patients with estrogen deficiency had significantly worse carbohydrate metabolism and lipid profile. Liver function tests were significantly higher in the group of female patients with PM. FLI coefficient was 30.0 and 41.5 in patients of groups 2 and 3, respectively, versus 9.0 in group 1 (control). A negative correlation was found between the estradiol level and FLI coefficient (r = -0.524; p 0.001). FLI index became more sensitive than ultrasound data for assessing the degree of steatosis and NAFLD incidence.
Conclusion. PM negatively affects female’s metabolic health. Early diagnosis and prevention of NAFLD in female patients with POF will prevent irreversible liver changes and reduce the risk of cardiovascular complications.



Results of the analysis of the condition and quality of dispensary observation of type 2 diabetes mellitus patients
Abstract
Abstract. Tendency towards an increase of the prevalence and mortality due to diabetes mellitus (DM) actualizes the problem of the quality of dispensary observation (DO), which cannot be solved without the planned implementation of appropriate treatment and diagnostical measures.
The aim: to estimate the condition and quality of DO of patients with type 2 DM (T2DM) based on existing regulatory legal acts.
Material and methods. The data of 1395 medical records of patients with T2DM who received medical care in medical organizations of a large industrial center of the Perm Territory (form No. 025/u), State Register of Diabetes Mellitus (SRDM) of the Perm territory, report form No. 12 (“Information on the number of diseases registered in patients living in the service area of a medical organization”) were analyzed. The compliance of the obtained results with DO recommendations were determined by an expert method. The set of DO assessment indicators included volumetric and qualitative indicators, which were compared over a 5-year period.
Results. The study revealed defects in medical records maintaining in 90.4% of cases, failure to comply with the standard for the volume and frequency of treatment and diagnostic measures. Thus, in 2019, 39.2% of patients were consulted by an endocrinologist (44.6% in 2023) and 20% by an ophthalmologist. The target index of glycated hemoglobin, one of the indicators of DO quality, was noted in the medical record in 88.5% in 2023, and in 51.6% of patients with T2DM in 2019. In 2023, the frequency of determining this indicator (3–4 times a year) corresponded to regulatory documents in 4.1% of cases. Other indicators characterizing DO also revealed deviations of actual results from the normative ones set forth in the standards.
Conclusion. The efficacy of the strategy and tactics of DO organizing for patients with diabetes mellitus is determined by the completeness and frequency of implementation of the normative measures set forth in the standards. An assessment of the results of DO T2DM patients showed a discrepancy between the volumes of its implementation and the normative documents, which indicates an unsatisfactory quality of medical care. At the same time, despite the existing violations of standards by doctors, a comparison of the results of dynamic observation over a 5-year period indicates positive tendencies in that area.



Estimation of extended medical examination coverage indexes in young individuals after novel coronavirus infection
Abstract
Abstract. The consequences of novel coronavirus infection (COVID-19) are manifesting themselves in individuals, including young people, in the form of persistent complaints in the period ≥ 6 months after the recovery. At the same time, patients with chronic infectious diseases (CNDs) need special attention and timely diagnosis of the post-COVID state to prevent complications. A range of extended medical examination measures is carried out for the early detection of COVID-19 complications.
The aim: to estimaye the coverage rates of extended medical examination of young patients after COVID-19.
Material and methods. A retrospective cross-sectional analysis of 339 medical records of outpatients aged 18 to 44 years who had COVID-19 was performed. Complaints, the presence of concomitant CNDs, and the fact of undergoing a medical examination were assessed.
Results. The analysis included data from 40.4% of male and 59.6% of female patients (median age – 31.7 years). Mild degree of COVID-19 severity had 95.6% of patients, moderate – 4.4%, 98.5% of those studied were treated on an outpatient basis. Among patients with chronic pathologies, 29.5% had one disease, 13.6% had two, and 6.5% had three or more diseases. In the structure of CNDs, the leading ones were chronic autoimmune thyroiditis (6.8%), chronic tonsillitis (6.5%), and arterial hypertension (6.5%). Complaints related to COVID-19 after the recovery were made by 85 patients with CNDs (25.1%), including complaints of weakness (23.5%), dizziness and headache (23.5%), palpitations and chest discomfort (17.6%). Mandatory medical examination was undergone by 45 (13.3%), and expanded medical examination was undergone by 18 persons (5.3%). Among patients with CNDs, similar indexes were 30 (17.9%) and 13 (7.7%) persons, respectively.
Conclusion. Coverage of young individuals who have had COVID-19, including patients with existing CNDs, with preventive measures is not effective enough.



Analysis of the structure of comorbidity in patients with severe anemia
Abstract
Abstract. According to 2021 data, every fourth citizen of the world suffered from anemia. Anemia is a polyetiological condition making worse the course of other diseases, especially in comorbid patients. However, at the moment, correlation between anemia and comorbidity has not been fully studied.
The aim: to analyze the structure of comorbidity in patients with severe anemia (SA).
Material and methods. Retrospective continuous study was performed on the basis of therapeutic department of Central City Hospital No. 20, Yekaterinburg. Socio-demographic characteristics, diagnosis, laboratory and instrumental examinations and treatment of 105 inpatients (41% female patients) were analyzed. The inclusion criteria for the study were age over 18 years and “severe chronic anemia” diagnosis.
Results. The average age of patients was 62 ± 15.2 years old. In 89.5% of cases, patients were referred to the hospital by an outpatient institution, the rest applied for help on their own. The main causes of anemia were oncological (30.5%), gastroenterological (19.0%), gynecological diseases (11.4%). In a third of patients, the etiology of SA remained unknown. Studied individuals had from 0 to 12 chronic non-infectious pathologies. According to the Charlson index, 22.9% of patients had a 96–98% probability of 10-year survival, the minimum level of this index was (0%) in 2.9% of surveyed. According to CIRS-G scale, 89.5% of participants had a comorbidity score of 6, which reflects a severe health condition. The average levels of Charlson and CIRS-G indexes in patients with SA associated malignant neoplasm were significantly higher than among patients with SA associated with other diseases.
Conclusion. Understanding the structure of comorbid pathology in SA patients will help to develop an individual approach to them which will allow to treat both the main and concomitant diseases, as well as reduce mortality rate and the number of hospitalizations.



Analysis of antibacterial drugs prescriptions for adult patients with acute and chronic rhinosinusitis during outpatient treatment in the russian federation
Abstract
Abstract. Treatment of acute bacterial rhinosinusitis has become a challenging task due to the progressive development of the stability of respiratory pathogens to antimicrobial remedies.
The aim: to analyze the prescription of antibacterial drugs to adult patients with acute and chronic rhinosinusites during their outpatient treatment.
Material and methods. According to the data of sociological online survey of 627 otorinolangologists through electronic mailing (the author’s technology was used), the prescriptions of antibacterial drugs in case of maxillary sinus inflammatory diseases were studied in real clinical practice.
Results. During the initial visit of the patient 62% of doctors immediately prescribe antibiotics in case of acute (ARS) and 98.9% in chronic rhinosinus (CRS). The duration of antibiotic therapy for ARS in most cases (52.48%) is 7 days, for CRS - 10 days (43.22%). The most frequently prescribed antibiotics on the outpatient stage in the treatment of rhinosinusitis are penicillins: with ARS, they are recommended by 91.04%, with CRS without polyps – by 81.29% of specialists. Cephalosporins occupy 2nd place among the antibiotics prescribed both for ARS (50.4%) and CRS (60.97%). 21.92% of respondents with ARS and 25.47% with CRC use parenteral administration of cephalosporins in outpatient practice. Macrolides are prescribed by 30.08% of doctors in case of ARS and 40.48% for CRS, and the most popular medicine of this group is azithromycin. Fluoroquinolones are recommended by 8.16% of otorinolaryngologists for ARS and 22.9% for CRS.
Conclusion. Technology of physician’s self-assessment of his “minuses” in the management of patients with ARS and CRS through the electronic distribution of a questionnaire developed by the authors makes it possible to summarize data in the context of different regions and constituent entities of the Russian Federation, make conclusions on this issue on a national scale and study the readiness of the medical community to counter the risks of public health losses from the formation of pathogens’ resistance to antimicrobial agents. The results of online survey of 627 otorhinolaryngologists will improve the educational level of doctors in matters of antibiotic resistance and reduce the risks of excessive misprescription of antibacterial drugs.



Peculiarities of the clinical course of myocardial infarction associated with malignant neoplasms of various stages and localizations at the hospital period
Abstract
Abstract. Cardiovascular and oncological diseases are the leading causes of fatal outcomes. Due to constantly improving approaches to the management of these pathologies, the prognosis and life expectancy of such patients are improving.
The aim: to identify the peculiarities of myocardial infarction (MI) clinical course in patients with malignant neoplasms (MN) in multidisciplinary hospital conditions.
Material and methods. Medical records of 456 patients treated at I.I. Dzhanelidze research institute of emergency care from 2017 to 2022 with MI associated with MN were processed. Patients were divided into three groups: I – with MI and a history of cancer (n = 162), II – with MI and current oncological process (n = 194), III (control) – with MI without MN (n = 100). Gender, age, presence/absence of ST segment elevation on electrocardiogram (ECG), class of acute heart failure (AHF) according to Killip, functional classes of heart failure, cardiac arrhythmias, type of malignant neoplasm, and hospital mortality were assessed.
Results. In patients with current oncological process, MI with ST segment elevation was more commonly occured, in those with previous malignant neoplasm more commonly occured MI without ST segment elevation. In the latter, AHF was often not detected, while AHF of Killip classes 2–4 developed with greater frequency in patients of group II. The percentage of patients with chronic kidney disease stages 3b–4 was higher (38.7%) in the sample of patients with active malignant neoplasms, while among patients with previous malignant neoplasms it was 20.9%, and in those with MI without malignant neoplasm – 15%.
Conclusion. Patients with active malignant neoplasms had such features of MI course as a higher prevalence of ST-segment elevation on the ECG and more severe acute heart failure; in addition, they most often had gastrointestinal malignant neoplasms. Patients with a history of cancer more often did not have acute heart failure and had a not often variant of MI with ST-segment elevation.



Correlation between non-alcoholic fatty liver disease and intestinal microbiota dysbiosis
Abstract
Abstract. Non-alcoholic fatty liver disease (NAFLD) is a common disease characterized by excessive accumulation of fat in hepatocytes in individuals having metabolic dysfunction and not addicting to alcohol. The pathogenesis of NAFLD is multicomponent, it involves various metabolic and genetic factors. Studies from recent years show a correlation between NAFLD and intestinal microbiota, which plays a key role in the development and progression of this kind of pathology. Current review discusses the influence of intestinal microbiota and microbial metabolites at the main points of NAFLD pathogenesis. Factors contributing to the development of intestinal dysbiosis, as well as modern possibilities of modulating intestinal microflora as an integral component of NAFLD pathogenetic therapy are also considered.



REVIEWS
Advantages of combined use of sodium-glucose co-transporter type 2 inhibitors and glucagon-like peptide-1 receptor agonists relatively to cardiovascular and renal outcomes in patients with type 2 diabetes mellitus
Abstract
Abstract. Modern classes of hypoglycemic drugs, such as sodium-glucose co-transporter type 2 (SGCT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, have been shown in large-scale studies to reduce cardiovascular risk in patients with type 2 diabetes mellitus (T2DM), as well as the ability to have a positive effect on renal function. At the same time, these classes of drugs have their own peculiarities: for example, SGCT-2 inhibitors demonstrated better effects in terms of reducing hospitalizations for heart failure and decreased renal function, while GLP-1 receptor agonists to a greater extent reduced the risk of cardiovascular and cerebrovascular events.
The aim of the review is to analyze the data of clinical trials and meta-analyses reflecting the effect of SGCT-2 inhibitors and GLP-1 receptor agonists, both in isolation and in combination, on cardiocerebrovascular and renal outcomes in patients with T2DM, as well as to analyze the mechanisms of drug action which predetermined obtained results.



Adrenal incidentalomas
Abstract
Abstract. Recent widespread use of radiation research methods has led to more frequent detection of adrenal tumors – incidentalomas. In most cases, they are non-functioning adenomas of the adrenal cortex, but anyway they may require therapeutic intervention, especially in case of adrenal cortex carcinoma, hormone-producing adenoma, or metastases. In 2023, The European Society of Endocrinology published a revised version of the first international multidisciplinary guideline concerning incidentalomas. The article provides a brief overview of modern approaches to the management of such kind of patients.



Obstructive sleep apnea syndrome, diabetes mellitus and cardiovascular complications
Abstract
Abstract. The review analyzes current data concerning the correlation between obstructive sleep apnea syndrome (OSAS), diabetes mellitus (DM) and cardiovascular complications. The results of research work dedicated to the effect of OSAS at glucose metabolism, its role in the development of cardiovascular diseases and their complications are considered. Also information about the effect of DM at the risk of this syndrome developing is presented. Controversial aspects of the efficacy of OSAS therapy (CPAP therapy and weight loss) from the standpoint of reducing the risk of cardiovascular complications development are also covered in the article.



Asymptomatic hyperuricemia in the practice of endocrinologist: pleiotropic action of antihyperglycemic drugs
Abstract
Abstract. Asymptomatic hyperuricemia (AH) is a common laboratory finding in comorbid patients. Currently, AH is considered to be an independent component of metabolic syndrome (MS), affecting the outcomes of cardiac pathology. Detection and correction of AH in patients with type 2 diabetes mellitus is an important task of the therapeutic care. In treatment of comorbid patients, the idea of selecting drugs with pleiotropic effects affecting different components of MS, including those that help reduce uric acid levels, is very actual. Among hypoglycemic drugs, the hypouricemic effect has been described for sodium-glucose co-transporter type 2 inhibitors, dipeptidyl peptidase type 4 inhibitors, and thiazolidinediones. The use of drugs with pleiotropic action will potentially reduce the dose of allopurinol. Influence of combinations of these groups of hypoglycemic drugs at AH should be the subject of further research works.



Modern opportunities for residual cardiovascular risk reducing
Abstract
Abstract. Statin therapy reliably reduces the concentration of low-density lipoprotein cholesterol, but is not always effective in improving the overall lipid profile, which creates the preconditions for residual cardiovascular risk genesis. Fibrates, peroxisome proliferator-activated receptor-α agonists, are potent lipid-modifying drugs. The main effects include lowering triglyceride levels and increasing high-density lipoprotein levels. Several randomized controlled clinical trials have failed to demonstrate the benefit of fibrates in reducing cardiovascular risk, especially as an addition to statin therapy. However, retrospective analyzes of large-scale clinical trials, meta-analyses, and real-practice data confirm their therapeutic potential in populations of patients having atherogenic dyslipidemia and metabolic syndrome. The review presents an analysis of current scientific literature on the problem of mixed dyslipidemia and cardiovascular complications risk correction.



CLINICAL CASES
Treatment of weight re-gaining after gastric bypass operation in female patient with morbid obesity and diabetes mellitus
Abstract
Abstract. Obesity (OB) is a common disease that leads to a significant increase in cardiovascular risk due to the development of insulin resistance, carbohydrate metabolism disorders, and dyslipidemia. The most effective method for treating OB and OB-associated conditions is bariatric surgery. In recent years, the data on weight regain (WR) and recurrence of OB in patients who were not complying with postoperative diet recommendations, physical activity, and doctor visits are accumulated in the literature. As a rule, WR leads to worsening glycemic control, deepens insulin resistance and dyslipidemia. In addition, the restrictive and malabsorptive components of modern bariatric interventions require taking vitamin and mineral supplements, since developing deficiency conditions can lead to serious complications. The article presents a clinical case of a female patient with morbid OB and type 2 diabetes mellitus, who developed WR and complications caused by vitamin and mineral deficiency.



Severe osteoporosis against primary ovarian failure in triplet sisters
Abstract
Abstract. During menopause period, the risk of osteoporosis and pathological fractures increases, especially with its immature or early onset. Both heredity and possible prenatal developmental disorders play a significant role in the development of these conditions, especially in children born from multiple pregnancies. This emphasizes the necessity for special attention to females from the risk groups for their timely referral to specialized professionals, prescription of treatment for osteoporosis and consideration of the possibility of using menopausal hormone therapy. The article describes clinical cases of severe osteoporosis that developed in triplet sisters in connection with immature or early menopause. The interest of the presented observations could be explained by fact of the lack of treatment and referral to an endocrinologist for patients with multiple pathological fractures in their anamnesis, which indicates insufficient awareness of these diseases among doctors of other specialties.



Adrenal hemorrhage in a patient with pheochromocytoma manifested under the mask of acute surgical pathology
Abstract
Abstract. Spontaneous adrenal hemorrhage is a rare, potentially life-threatening condition. The most common cause of its arising (almost 50% of cases) is pheochromocytoma, which worsens the negative prognosis due to the high probability of developing a catecholamine crisis. In current clinical case, the presence of abdominal pain with hemodynamic shock in an elderly female patient, as well as a history of malignant arterial hypertension with a specific crisis course, gave a cause for concern of pheochromocytoma with hemorrhage in the adrenal gland. Emergency surgery in this case is associated with a higher risk of fatal complications. The main goal of preoperative preparation of such kind of patients is to normalize blood pressure, heart rate, restore the effective volume of circulating blood, and prevent catecholamine crisis intraoperatively. Prolonged α-adrenergic receptors blockade improves the course of perioperative period and the prognosis in the whole.



Efficacy of Remaxol in complex treatment of chronic viral hepatitis C
Abstract
Abstract. The article presents a clinical case of successful treatment of a young patient from chronic viral hepatitis C using an integrated therapeutic approach, including not only an etiotropic, but also a pathogenetic component – infusion of the polyionic succinate-containing drug Remaxol. In this clinical observation, a rapid effect of Remaxol was noted on the signs of cytolytic syndrome in chronic viral hepatitis C, manifested in a decrease in the activity of liver transaminases and a decrease in patient complaints.



ACTUAL ISSUES OF PHARMACOTHERAPY AND PREVENTIVE TREATMENT
New therapeutic opportunities of gastroprotection in cardiology
Abstract
Abstract. The successes achieved with additional effects on blood coagulation in the secondary prevention of atherothrombosis determine the widespread use of combination antithrombotic therapy among cardiac patients. However, this trend has not gone unnoticed in gastroenterological practice: antiplatelet agents and anticoagulants have taken leading positions as the main agents causing gastrointestinal complications. At the same time, currently existing clinical guidelines contain limited guidance on assessing hemorrhagic risks, and only proton pump inhibitors are considered as prophylactic drugs. The review is devoted to systematizing knowledge about the use of antithrombotic therapy a year after acute coronary syndrome from the standpoint of preventing bleeding from the upper gastrointestinal tract, taking into account the condition of the mucous membrane according to endoscopic examination, as well as modern gastroprotection opportunities.



Importance and efficacy of immunoprophylaxis of pneumococcal infection in adult population
Abstract
Abstract. Infections caused by Streptococcus pneumoniae are one of the most common causes of death worldwide. There are invasive and non-invasive forms of pneumococcal infection, the severity of which determines their high socio-economic significance. Vaccination is recognized to be the most effective method of preventing pneumococcal infections. Pneumococcal vaccine is placed in universal immunization schedules of 134 countries, including Russia. Use of conjugate pneumococcal vaccines is in priority of preventive vaccination performing. Vaccination against pneumococcal infections with 13-valent conjugate vaccine can significantly reduce the corresponding morbidity and mortality of these diseases.


