Vol 9, No 4 (2023)

This article discusses the issues associated with the phased introduction of mandatory implementation of clinical guidelines. It is shown that they can be considered as customs, and can be a source of law. The problems of gradual transition to mandatory implementation of clinical guidelines are highlighted and the possible responsibility of medical organizations for their non-compliance is considered. This issue leads to the inclusion in clinical guidelines of drugs and interventions with unproven effectiveness often contradicting modern scientific knowledge. It is proposed to return to the discussion of the mandatory status of clinical guidelines, leaving this requirement for the formation of programs of state guarantees of free medical care to citizens. It is proposed to involve the Russian Academy of Sciences in finalizing the guidelines, as well as to refine their structure by providing sections in it reflecting accumulated knowledge in the field of artificial intelligence and adherence to treatment.

The aim was to study the frequency and characteristics of non-steroidal anti-inflammatory medicines (NSAIDs) use in patients with cardiovascular diseases (CVD) hospitalized in emergency cardiology departments.

Material and methods. We examined 190 patients hospitalized in the emergency cardiology department of the Regional clinical hospital of Saratov from March to June 2022. It was the full-design study, questionnaire survey was made for all patients hospitalized during the specified period. The questionnaire contained questions regarding the main and concomitant diseases, NSAIDs intake during the month preceding hospitalization. The study involved 122 male and 68 female patients, and average age of them was 60,75±9,74 years old.

Results. During the month before admission to the emergency department, 52% of patients were using NSAIDs for various reasons. The main reasons for hospitalization in most patients were acute coronary pathology and decompensated heart failure. As the main reasons for NSAIDs intake, patients note musculoskeletal system disorders and headache. The majority of patients (65%) should take NSAIDs more than once a week, 39% of patients – for 3 months. 26% of patients used two or more NSAIDs simultaneously during the last month.

Conclusion. More than half of patients admitted to emergency cardiology departments had taken NSAIDs during the month prior to hospitalization. Most patients were bound to use NSAIDs often, regularly, for a long time. In this regard, active medical tactics is required to identify the fact and clarify the peculiarities of NSAIDs use in this category of patients. The choice of medicines in most patients remains suboptimal, often several of them are combined, and different methods of their administration are taking place. Thus, the situation with NSAIDs use in CVD patients requires additional informing both patients and doctors about the peculiarities of their use in this category of health care consumers.

Up to nowadays, there are practically existing no studies on complex research work concerning risk factors for atherosclerosis, lipid component, and genetic thrombophilia in type 1 myocardial infarction (MI) at the age of 25–44 years of patients.

The aim: to study proatherogenic factors and genetic thrombophilias in young patients with type 1 MI.

Material and methods. 100 male patients with type 1 MI aged 25–44 years were examined. Inclusion criteria: informed consent to participate in the study; MI type 1; age 25–44 years. Exclusion criteria: absence of coronary angiography; MI types 2–5; acquired thrombophilia; hypothyroidism; relationship with the patient included in the current study. The comparison group consisted of 100 male patients aged 42–44 years without MI. Risk factors for atherosclerosis and lipid profile were analyzed. 8 genes (1 polymorphism) of the hemostasis system were studied: blood coagulation factors I (FGB: -455G>A), II (F2: 20210G>A), V (F5: 1691G>A), VII (F7: 10976G>A), XIII (F13A1: 103G>T), inhibitor of plasminogen activator type 1 (PAI-1: -675 5G>4G), platelet receptors for collagen (ITGA2: 807C>T) and fibrinogen (ITGB3: 1565T>C).

Results. Young male patients with type 1 MI are characterized by smoking (53%; p <0,0001), arterial hypertension (72%; p <0,0001), type 2 diabetes mellitus (8%; p=0,041), heredity for early CAD (11%; p=0,022), abdominal obesity (45%; p <0,0001), obesity (45%; p <0,0001), carrier of heterozygous G1691A genotypes of the F5 gene (8%; p=0,041), T1565C of the ITGB3 gene (37%; p=0,012) and 5G(-675)4G of the PAI-1 gene (57%; p=0,007). There took place an increase in total cholesterol, LDL, triglycerides and a decrease in HDL. In 5% of patients, heterozygous familial hypercholesterolemia was verified. Based on multivariate analysis, the most significant factors associated with type 1 MI in young male patients were identified: smoking (p=0,010), hypertension (p <0,0001), LDL (p <0,0001), triglycerides (p=0,013), genotype -675 5G/4G of the PAI-1 gene (p=0,002).

Conclusion. Identification of genetic thrombophilias complements the identification of «traditional» proatherogenic factors and allows timely identificate a risk group for type 1 MI at a young age.

Nowadays, the aspect of the advisability of remote medical monitoring of chronic heart failure (CHF) patients still remains relevant.

The aim: to compare two strategies for managing patients with CHF after discharge from the hospital and to estimate the effectiveness of active outpatient monitoring model of CHF patients by means of telemonitoring use.

Material and methods. The study included hospitalized patients with decompensated CHF: group 1 (studied) – 70 persons who underwent telemonitoring after discharge; 2nd (control) group – 65 persons. The participants underwent a general clinical examination, quality of life (QoL) was determined according to the Minnesota questionnaire, an assessment was made according to the Self-help Capacity Scale for patients with CHF, adherence to treatment was assessed using the Morisky–Green questionnaire, anxiety and depression according to HADS-A and HADS-D, the number of calls ambulance teams and repeated hospitalizations was estimated within a year after discharge.

Results. In 12 months after inpatient treatment, positive dynamics was revealed in the study group: in comparison with the control group, the index of life quality according to the questionnaire in it was higher by 15.8 points, according to the self-help questionnaire – by 12,3 points, according to the Morisky–Green questionnaire – by 2,6 points. In addition, in the study group, the score for HADS-A was 3,1 less, and for HADS-D – 2,8 less than in the control group. Annual analysis showed that in the study group, emergency calls and hospitalizations were 4,9 times and 2,3 times less, respectively, than in the control group.

Conclusion. Active outpatient monitoring with the use of telemonitoring of CHF patients in a year after discharge from the hospital allows to increase the quality of life, ability to self-help, adherence to treatment, reduce the level of anxiety and depression, and the number of repeated hospitalizations.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medications. The main mechanism of action of these drugs is the inhibition of cyclooxygenase (COX). This mechanism is associated not only with the therapeutic effects of NSAIDs, but also with adverse drug reactions, in particular, an increase in cardiovascular risk. The purpose of this review was to summarize the currently available data on the cardiovascular safety of highly selective COX-2 inhibitors called coxibs. It has been shown that cardiovascular side effects are class-specific effects of NSAIDs, independent on COX-2 selectivity. In general, coxibs have cardiovascular safety comparable to non-selective NSAIDs with a better gastrointestinal safety profile. However, there are certain differences between effects of certain drugs on blood pressure, heart rate, heart failure, the frequency of fatal and non-fatal cardiovascular events.

Reducing the relative risk of cardiovascular events is proportional to the absolute reduction of low-density lipoprotein cholesterol (LDL cholesterol), which is the main goal of therapy, regardless of the method of reduction. During the past decades, therapeutic algorithms of hypercholesterolemia correction have been improved, providing clinical benefits in terms of cardiovascular outcomes. Current review is dedicated to currently available lipid-lowering drugs: statins, ezetimibe, PCSK9 inhibitors (monoclonal antibodies, small interfering RNA preparation) and bempedoic acid. Recent changes in lipid-lowering regimens are also discussed, including the early use of lipid-lowering drug combinations to achieve relatively low LDL-C targets in patients at high/very high CV risk.

The article presents a clinical case of amyloid cardiomyopathy that developed in the presence of T-cell leukemia from large granular lymphocytes. The stages of diagnostic search are described, the causes of late diagnosis of the disease are analyzed. Pathogenetic substantiation of the mechanisms of development of plasma cell monoclonal dyscrasia against the background of T-cell leukemia is given. The presented clinical case shows the complexity and multi-stage character of the diagnosis of amyloid cardiomyopathy, need for rapid diagnosis due to the rapid progression of the disease.

Worldwide, the prevalence of chronic heart failure (CHF) is increasing every year, representing a serious medical and social problem. Medicinal drugs can help manage the symptoms of CHF and improve the prognosis in patients, but often the use of drug therapy alone may not be enough. Modern approaches to the treatment of CHF with low ejection fraction (CHFnEF), in addition to drug therapy, also include the use of various electrophysiological methods: implantation of cardioresynchronizing devices, cardioverter defibrillators, interventional treatment of arrhythmias. Article presents an analysis of a clinical case of successful treatment of a comorbid patient with severe CHFrEF using optimal drug therapy, as well as such interventional cardiac surgical interventions as implantation of a cardioresynchronization device with defibrillator function and radiofrequency ablation of arrhythmogenic heart zones.

The article presents current literature data on the mechanisms of iron absorption, activators and inhibitors of this process. Authors are analyzing the published data on the study of the regulation of iron entry into the blood, processes that stimulate and inhibit its absorption, describing in details hepcidin–erythroferron mechanism for iron metabolism controlling. Separately, there are provided the data on food products, nutritional supplements, existing and under study new drugs that change the degree of resorption of iron into intestinal cells, suppressing and potentiating the effect of hepcidin. Scientific studies on a new oral form of sucrosomial Iron, findings on the mechanisms of its absorption, peculiarities of use, and the results of biological and clinical studies are considered.

Vaccination is one of the priority areas in the implementation of the national policy for the development of the healthcare system, including the priority national project "Health", the program "Prevention and control of socially significant diseases", aimed at protecting Russian citizens from vaccine-preventable infections by improving the National Immunization Schedule (NCV). ) and the implementation of the "Strategy for the development of immunoprophylaxis of infectious diseases until 2035".

Chronic heart failure (CHF) still occupies a leading position in the structure of hospitalizations and mortality of patients. Studies of approaches to the treatment of this disease remains to be an urgent problem in the spectrum of attention of the medical community. Inhibitors of sodium-glucose cotransporter type 2 (IGLT-2), originally developed for the treatment of type 2 diabetes mellitus, in recent years are one of the most studied classes of medicines that have proven their efficacy in CHF treatment. Current article describes studied pharmacological mechanisms of iSGLT-2 action, presents an analysis of clinical studies on the use of this class of drugs in patients with CHF. The main attention is paid to the analysis of the DELIVER study, the results of which demonstrated the efficacy of dapagliflozin in treatment of heart failure patients with a moderately reduced and preserved left ventricular ejection fraction.

Chronic heart failure (CHF) in combination with chronic obstructive pulmonary disease (COPD) – common diseases in the clinical practice of a general practitioner.

Purpose: to study the effect of meldonium in the complex therapy on heart rate variability in patients with CHF and COPD.

Material and method. 60 patients were included in a randomized study. The age of the patients was 45–70 years. All the studied patients had CHF II A stage, II–III FC (clinical recommendations of the RSC, SHFS, 2020) and COPD I–III degree of airflow limitation (GOLD 2021 classification) without exacerbation. The patients were divided into 2 groups: the patients of the 1st group (the main group, n=30) with CHF and COPD received meldonium at a dose of 1000 mg/day in addition to the basic therapy, the patients of the 2nd group (the control group, n=30), were treated only basic drugs for CHF and COPD. The patients were followed up for 12 weeks.

Results. After 12 weeks of therapy with the inclusion of meldonium as part of the complex therapy of CHF and COPD, a significant decrease in the incidence of hypersympathicotonia, a decrease in the tension of the regulatory systems of the autonomic nervous system (ANS) was found.

Conclusion. A significant beneficial effect of meldonium as part of complex therapy on the state of the ANS in patients with CHF and COPD was established.

Functional constipation is a significant medical and social problem due to its growing prevalence and significant negative impact at well-being, psycho-emotional state and life quality in general. Disturbed rhythm of defecation is not always possible to normalize only by diet and regimen correction. Quite often, one has to resort to prescribing drugs with a laxative effect, the long-term use of which is leads to the development of addiction and other undesirable side effects. As a good alternative to medicinal treatment, as well as an addition to it, the use of therapeutic mineral waters should be considered. In foreign and domestic studies, high efficiency and safety of the use of magnesium sulfate-rich mineral waters for functional constipation is noted. Among them, the most obvious effect has natural mineral water Donat.