Vol 10, No 8 (2024)

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.