卷 10, 编号 5 (2024)

Intracerebral hemorrhages (ICH) are socially significant disease that not only has an immediate risk to life and health, but also leads to disability, long recovery period and socio-economic difficulties. Considering the prevalence and risks of ICH, identification its main characteristics in young individuals with an emphasis on etiology is an important aspect of its prevention and treatment.

The aim: to study the structure of hemorrhagic strokes, as well as etiological factors of ICH in young male and female patients in Novosibirsk region.

Material and methods. A retrospective analysis of 180 case histories of patients with acute cerebrovascular accidents aged from 15 to 46 years who were treated at the Regional Vascular Center No. 2 of State Novosibirsk Regional Clinical Hospital from 2021 to 2022 was performed.

Results. The main etiological factors of ICH in young individuals in studied population were arterial hypertension (AH), including the same in combination with other cardiovascular pathologies. Vascular anomalies took second place; and in 4% of cases, the causes of ICH remained unspecified. Only 65% of patients were aware of the presence of hypertension at the time of hospitalization with ICH; in other cases, it was not diagnosed before ICH encounter.

Conclusion. Arterial hypertension today is one of the main risk factors for morbidity and mortality in young patients with ICH. The diagnosis and treatment of hypertension should be given greater attention in younger patients as part of the primary ICH-related prevention strategy.

Population aging entails an increased incidence of age-associated diseases that are risk factors for cognitive impairment.

The aim: to еvaluate cognitive function (CF) of multimorbid patients aged ≥ 60 years with arterial hypertension (AH) depending on the Charlson comorbidity index.

Material and methods. Study participants (n = 330) were divided into 3 groups depending on the Charlson index: group 1 – 0–4 points (n = 69, median age 72 years), group 2 – 5–7 points (n = 182, median age 80 years), group 3 – ≥ 8 points (n = 79, median age 82 years). All patients were assessed for QF using a range of cognitive tests.

Results. The Montreal Cognitive Assessment Scale (MoCA) revealed statistically significant differences between groups 1 and 2, 1 and 3 (p = 0.032 and p < 0.001, respectively; maximum in group 1, minimum in group 3), on the Mini-Mental State Examination (MMSE) – between groups 1 and 3 (27 and 26 points respectively, p = 0.014), on the Alzheimer’s Disease Assessment Scale – Cognitive subscale (ADAS-Cog) – between groups 1 and 2 (12 and 15 points respectively, p = 0.011). Group 3 patients scored statistically significantly lower on the Boston Test compared to groups 1 and 2 (p₁₋₂₋₃ = 0.008). In the literal association’s subtest, group 3 patients named statistically significantly fewer words compared to patients in groups 1 and 2 (p = 0.002 and p = 0.006, respectively). In the Digit Symbol Substitution Test, statistically significant differences were recorded between groups 1 and 3 (p = 0.022). Statistically significant differences between the groups (p₁₋₂₋₃ < 0.001) were also found when evaluating the results of the maximum digit series memorization test.

Conclusion. The obtained results indicate a direct influence of the number of certain comorbidities and age of patients, which reflects the Charlson comorbidity index, on the severity of cognitive impairment in polymorbid elderly and senile patients with AH.

A significant correlation is shown in the number of studies between H. pylori infection and occupation of people. Higher H. pylori positivity was also found among medical professionals.

The aim: to analyze the characteristics of the clinical picture, personal and family history data in H. pylori-positive subjects, depending on their involvement in medical activities, and to identify some higher risk factors for the presence of H. pylori infection.

Material and methods. 182 individuals were examined, including 107 medical and 75 non-medical workers. H. pylori was diagnosed when antigen was detected in the stool. The presence and frequency of any symptoms, existing gastrointestinal tract (GIT) pathology, hereditary history of peptic ulcer (PU) and gastric cancer (GC) were assessed.

Results. H. pylori was detected in 128 individuals, including 72 medical and 56 non-medical workers. The level of H. pylori infection was 2.61 times higher among subjects with upper gastrointestinal symptoms (p = 0.008), 3.83 times higher among subjects with a personal history of erosive and ulcerative diseases (p = 0.012), 8.12 times higher – with a family history of gastric cancer (p = 0.019). The structure of symptoms was dominated by pain in epigastric area (p = 0.005), heartburn (p = 0.022) and belching (p = 0.033). Medical professionals were 3.83 times more likely to have a family history of GU, regardless of H. pylori status (p = 0.007), and H. pylori infection was positively associated with a family history of gastric cancer (odds ratio 6.8; 95% confidence interval: 0.85–54.59, p = 0.041).

Conclusion. High risk of H. pylori infection is associated with individuals having upper gastrointestinal symptoms (such as epigastric pain, heartburn and belching), a personal history of erosive and ulcerative lesions and a family history of gastric cancer, regardless of professional background. Medical professionals were more likely to have a hereditary history of ulcers, regardless of H. pylori status, and gastric cancer with H. pylori positivity.

Orthostatic hypotension (OH) occurs more frequently in patients with diabetes mellitus (DM), than in general population.

The aim: to identify risk factors for OH in patients with DM and impaired glucose tolerance (IGT), its correlation with autonomic dysfunction and medicamentous antihypertensive therapy.

Material and methods. The study included 70 patients with treated arterial hypertension with DM or IGT (mean age 65.8 ± 19 years). Orthostatic response was assessed using the active test method; OH was estimated when systolic blood pressure (SBP) decreased by 20 mm Hg and/or diastolic by 10 mm Hg. Autonomic symptoms of diabetic neuropathy were assessed using SAS (Survey of Autonomic Symptoms) scale.

Results. 21 patients (30%) had OH, and remaining 49 (70%) did not have it. In patients in the compared groups, the average age was comparable, but patients with OH were 27.2% more likely (x² = 4.444, p = 0.036) to be older than 65 years. The incidence of controlled hypertension, atrial fibrillation, heart failure, diabetic polyneuropathy and nephropathy (glomerular filtration rate < 60 ml/min.) did not differ depending on the presence/absence of OH. In patients with OH, anemia was 3.9 times (x² = 19.66, p < 0.05) more common. The frequency of use of combined 2-, 3-, 4-component antihypertensive therapy in patients of the analyzed groups was comparable. The total assessment of orthostasis, vasomotor and sudomotor reactions according to SAS questionnaire of less than 10 points in patients with OH was 2.3 times less frequent (x² = 4.207, p = 0.041) comparatively to persons without OH: 19% (n = 4) versus 44.9% (n = 22). There was a moderate direct correlation between the total score on SAS questionnaire and age (r = 0.48, p = 0.034), change in SBP (in mm Hg) during an orthostatic test (r = 0.29, p = 0.049). By constructing single-factor logistic regression models, predictors of OH development were identified. Anemia, atherosclerosis of peripheral arteries, pulse pressure above 60 mm Hg are among them.

Conclusion. In 30% of patients with DM and IGT, OH is detected, in most of them (70%) – in the 1st minute of an active orthostatic test. Patients with OH are characterized by a higher incidence of anemia and more often have an elderly age. Patients with DM tend to have a higher incidence of OH comparatively to individuals with IGT. Medicamentous combined antihypertensive therapy was comparable in patients with and without OH.

In the modern world, negative after-effects of COVID-19 pandemic are being actively studied. New coronavirus infection aggressively affects many organs, including male reproductive system, binding to ACE 2 receptor on the surface of cells of the reproductive organs. The virus activates oxidative stress and hyperproduction of cytokines, which negatively affects testicular cells, causing hypogonadism and erectile dysfunction in young male individuals.

The aim: to estimate the possibility of hypogonadism correction and restoration of erectile function in young male patients underwent COVID-19 using a transdermal gel form of testosterone.

Material and methods. 104 male individuals aged 20–45 years were included in the study. The main group consisted of 75 patients who had COVID-19 in the past, control group – 29 healthy individuals. During the period of COVID-19 illness and after 12 weeks after the recovery, body mass index, levels of luteinizing and follicle-stimulating hormones, total testosterone were determined, and the IIEF-5 questionnaire (International Index of Erectile Function) was used for erectile function assessment.

Results. 80% of male patients had a reduced total testosterone level (p < 0.01) during the period of COVID-19 disease. According to the results of the IIEF-5 questionnaire, in the main group with COVID-19, erectile dysfunction was detected in 81% of cases (p < 0.01). In 12 weeks after the recovery, 64% of the surveyed males had low levels of total testosterone (p < 0.01); according to the results of the IIEF-5 questionnaire, sexual disorders persisted in 44% (p < 0.01). During 12 weeks of transdermal gel testosterone replacement therapy, all examined male patients experienced a significant increase in testosterone levels (p < 0.01) and 100% satisfaction with erectile function (p < 0.01).

Conclusion. Testosterone replacement therapy improves total testosterone and sexual function in young male patients with hypogonadism arised after the past COVID-19.

Aspects of correlation between cerebrovascular diseases (CVD) and metabolic disorders that are extremely actual due to the pandemic increase of the incidence of obesity (OB) and diabetes mellitus (DM) are discussed in the article. The number of brain strokes in the world and problems of associated medical and social consequences are constantly increasing. The problem of effective primary prevention of CVD has not been solved, which determines the need for stratification of high-risk individuals and early diagnosis of vascular cerebral pathology. Influence of a wide range of biologically active molecules associated with obesity and diabetes mellitus at the development of cerebral vascular pathology has been shown; pro-inflammatory, pro-atherogenic and pro-thrombogenic effects of metabolic disorders have been fixed. Determining a biomarker panel of cerebrometabolic pathology may become a significant milestone in the development of strategies for the prevention and treatment of cerebrovascular diseases.

Problem of cerebral vascular pathology has serious medical and socio-economic consequences for the nation. The fastest growing risk factors for stroke are metabolic disorders – obesity and diabetes mellitus, which not only increase the probability of developing acute cerebrovascular accidents, but also negatively affect the course and prognosis of cerebrovascular diseases (CVD). Article discusses the mechanisms of CVD development in conditions of metabolic disorders and also approaches to the treatment of comorbid patients.

Wernicke encephalopathy (WE) is a difficult to recognize, urgent, but potentially curable by high doses of thiamine pathology. In the absence of specific treatment or with a late starting of it, the disease is associated with the development of severe cognitive impairments (Wernicke – Korsakoff syndrome) or death. Although WE most often develops in patients with alcoholism, many cases of it have a non-alcoholic origin. The article describes a clinical case of WE in a 37-year-old patient who denies alcohol consumption, but has a history of dietary restrictions with severe weight loss. Differential diagnosis was carried out with demyelinating disease of the central nervous system, chronic inflammatory demyelinating polyneuropathy. Presented clinical case demonstrates the difficulties of WE diagnosing in patients without a clear alcohol history.

Diabetes mellitus (DM) is a not fully studied chronic progressive metabolic disease with multiple complications such as diabetic foot syndrome, retinopathy, and nephropathy. In the context of diabetes, undeservedly little attention is paid to pulmonary lesions, especially if they lead to the development of diabetic lung or have an influence at the pathogenesis of a pulmonary pathology, such as chronic obstructive pulmonary disease or bronchial asthma. Current review summarizes ideas about the role of diabetes in the formation of pulmonary tissue pathology, especially in cases of idiopathic pulmonary fibrosis development in diabetes mellitus patients – a progressive disease with high mortality and limited treatment options.

Current resolution represents the key characteristics and peculiarities of an innovative drug development – a domestic pharmaceutical product for the treatment of a wide range of cardiovascular diseases, designated by GRS code. Mechanisms of action and spectrum of effects, results of clinical trials (CTs) of phases I and II, prospects for using the drug in therapeutic practice, as well as the main and additional directions of the planned phase III CTs are considered.

Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) have a number of common risk factors with central nervous system lesions, and are also an independent cause of the development of cerebrovascular, neurodegenerative, cognitive and mental disorders. The article represents the second and final part of the literature review, devoted to molecular mechanisms of neuroprotective action of sodium-glucose cotransporter inhibitors (gliflozins), which are of greatest importance in the context of correction of neuropsychiatric complications of NAFLD and NASH.