Clinical nutrition and metabolism

BACKGROUND: Elevated plasma osmolality is recognized as a predictor of mortality in cardiovascular diseases, including stroke; however, the association between plasma hyperosmolality and mortality in severe acute ischemic stroke (IS) remains to be fully elucidated.

AIM: This study aimed to investigate the association between plasma osmolality and mortality in patients with severe IS, considering stroke subtype.

METHODS: This study included 150 patients with severe IS of various localizations within 24 hours of symptom onset. All patients had a first-ever stroke, including 61 with cardioembolic and 89 with atherothrombotic subtypes. Plasma and urine osmolality were measured, along with key plasma osmolytes: sodium, potassium, glucose, urea, and protein, as well as urinary sodium levels. Plasma antidiuretic hormone and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were also assessed.

RESULTS: Among water-electrolyte disturbances in severe IS, hyperosmolar syndrome occurred 2.5 times more frequently than hypoosmolar syndrome. Hyperosmolar syndrome was 1.5 times more common in patients with the atherothrombotic subtype than in those with the cardioembolic subtype. Hyperosmolar syndromes in stroke were associated with a higher mortality rate (69.3%) compared to hypoosmolar syndromes.

CONCLUSION: The obtained results on the association between plasma osmolality and mortality in patients with severe IS indicate that hyperosmolar syndromes are the most common type of water-electrolyte disturbances and are more frequently observed in the atherothrombotic rather than the cardioembolic subtype. The identified association between osmolality and mortality highlights the need for new treatment strategies targeting water-electrolyte disturbances in severe IS.

BACKGROUND: Despite existing evidence supporting the effectiveness of nutritional support in oncology care, its practical implementation by oncologists remains insufficient.

AIM: This study aimed to assess practicing oncologists’ awareness of the key provisions of the Russian Society of Clinical Oncology (RUSSCO) guidelines on the diagnosis and treatment of cancer-related malnutrition and to determine their adherence to these recommendations.

METHODS: A survey was conducted among oncologists. The questionnaire included nine statements addressing respondents’ awareness of the provisions of the RUSSCO clinical guidelines on nutritional support and the frequency of its prescription, oncologists’ adherence to Enhanced Recovery After Surgery protocols, as well as their general attitude toward nutritional status screening.

RESULTS: A total of 233 questionnaires were analyzed. The RUSSCO guidelines on nutritional support were known to 179 (76.8%) respondents; nutritional assessment tools were recognized by 54.1% (n = 126), and 43.3% (n = 101) applied them in practice. Sip feeding was recommended by 146 (62.7%) doctors. Nutritional support was provided preoperatively by 43.8% (n = 102), during chemotherapy by 54.5% (n = 126), during radiotherapy by 36.1% (n = 84), and postoperatively by 60.1% (n = 140) respondents. Adherence oncologists to ERAS protocols regarding preoperative fasting and fluid restriction did not exceed 10%. The vast majority (96.6%) of respondents considered nutritional status assessment important.

CONCLUSION: Despite a relatively high level of awareness of clinical recommendations on nutritional support and general acceptance of nutritional status screening, therapeutic nutrition was practically prescribed by only 36.1% to 62.7% of respondents. To shift the paradigm in the prescription of therapeutic nutrition, educational efforts and further studies demonstrating its effectiveness, particularly in the context of ERAS protocols, are required.

The changing landscape of tobacco products dictates a new paradigm in smoking cessation efforts, which makes the understanding of nicotine metabolic aberrations, its neurobiological effects, and its pathophysiological impact on the human body still relevant. For this purpose, an analysis of publications on the topic was conducted using the medical databases eLIBRARY.RU, PubMed, and Medline (for the period 2000–2024). According to the obtained data, nicotine, a tobacco alkaloid, has a high affinity for brain tissues and produces a range of pharmacological effects, including positive psychoactive effects, leading to the development of strong dependence. Treatment of nicotine dependence involves pharmacotherapy, nicotine replacement therapy, and motivational counseling.

Nicotine, although it causes dependence, is not the main cause of smoking-related diseases. The main harm to health is caused by tobacco combustion products.

Alternative nicotine delivery systems, such as heated tobacco products and certified electronic cigarettes compliant with Russian national standards, may potentially reduce smoking-related harm, as they do not involve combustion. Electronic cigarettes, or vapes, use liquids, including those containing nicotine, whereas heated tobacco products heat actual tobacco without combustion, which significantly reduces the levels of harmful substances emitted compared to cigarette smoke.

These devices are gaining popularity and are the subject of active research. Comprehensive studies of all types of nicotine-containing products available on the Russian Federation market, including heated tobacco products and electronic nicotine delivery systems, are currently of high relevance. These studies should aim to evaluate their impact on consumer health in comparison with traditional cigarette smoking, to assess the potential for integrating their results into clinical guidelines for the prevention and treatment of tobacco-related diseases, and to support the development of up-to-date differentiated regulation in accordance with the actual risk profile of various nicotine-containing products.

Considering that modifying smoking-related risk factors remains a highly challenging task, understanding nicotine metabolism, its effects on the human body, and the harm reduction approach implemented through switching from cigarette smoking to alternative nicotine delivery systems may have a positive impact on increasing life expectancy among adult smokers who are not motivated to quit.