Vol 13, No 2 (2022)

Background: Pericarditis, following pericardiotomy, is a well-known complication of cardiac surgery. The diagnosis of postpericardiotomy pericarditis (PP) is based on the electrocardiography (ECG) changes — the ST segment elevation in combination with a depression of the PR interval. However, in some cases, the ECG changes are difficult to distinguish from the changes associated with ST segment elevation acute coronary syndrome. In such cases, the diagnosis of pericarditis is made by excluding acute coronary syndrome, for which additional expensive diagnostic tests are performed. Aims: the purpose of the study is to identify a pattern in the change in the PR interval, which is detected in patients with acute pericarditis who underwent pericardiotomy during coronary bypass surgery. Methods: The observational study included 47 patients after coronary bypass surgery. We compared ECG of two groups of patients after coronary artery bypass grafting — 25 patients who demonstrated the ECG signs of acute pericarditis and 22 patients without those. Results: In most patients with PP after coronary bypass surgery, the characteristic ECG signs of acute pericarditis were accompanied by a transient shortening of the PR interval by 0.04 sec. Conclusion: The absence of such dynamics in patients after coronary artery bypass grafting without the ECG signs of pericarditis may indicate that a transient shortening of the PR interval may be an additional easily available ECG sign of acute PP.

Background: The use of artificial circulation in surgical myocardial revascularization is one of the key pathogenetic factors in the development of the oxidative stress and systemic inflammatory response in the postoperative period. Aims: the purpose of the study was to describe the dynamics of the induced blood oxidation parameters during coronary artery bypass surgery in the conditions of artificial circulation and on the working heart. Methods: The study included 64 patients who underwent coronary bypass surgery, with 31 (48.4%) on-pump patients and 33 (51.6%) off-pump patients. The oxidative stress simulations were conducted under the in vitro conditions. The blood oxidation-induced values were studied using a biological oxygen monitor. Results: In patients with coronary heart disease, regardless of the choice of the revascularization method (on-pump / off-pump), we observed statistically significantly (p <0.05) higher initial and maximum blood oxidation rates, the oxidative activity factor, and a shorter initiation period than those in healthy volunteers. No significant differences were found by the inter-group comparison analysis both 10 days and 6 months post-surgery. Conclusion: The indicators of induced blood oxidation do not depend on the method of revascularization during coronary bypass grafting (artificial circulation or a working heart). The changes in the parameters indicating activation of the oxidative and antioxidant blood systems may be transient by their nature and occur in the early postoperative period.

Background: The quality of life of patients is one of determining factors in assessing the effectiveness of treatment and prognosis. A search for possible associations of the quality of life parameters with basic clinical indicators provides a possibility of a more detailed and comprehensive assessment of the patient’s condition, correction of therapy and an improvement in the prognosis. Aim: To carry out a comparative analysis of the quality of life parameters in patients with chronic heart failure (CHF) with preserved and moderately reduced left ventricular ejection fraction against the background of rheumatoid arthritis (RA) and without RA, as well as to identify possible associations of the quality of life indicators with the parameters of the CHF course. Methods: 134 CHF patients with an RA diagnosis were examined, as well as 122 CHF patients without RA. The functional class of CHF in patients participated in the study was I -II by NYHA. The diagnosis of RA was made on the basis of radiological and serological studies. The radiological stage of RA in patients included in the study was I -III, according to Steinbrocker. Methotrexate was the basic anti-inflammatory drug for the RA treatment. A comparative analysis of the CHF symptoms, morphofunctional parameters and their possible association with the quality of life indicators in patients with and without RA was performed. The processing was carried out using the Statistica 10.0 program. Results: In the group of patients with CHF and RA, in addition to the statistically significant differences in the standard clinical laboratory parameters, statistically significant differences were also revealed in the severity of pain syndrome, deterioration of role, physical and emotional functioning as compared to the CHF patients without RA. Besides, in the CHF/RA group, statistically significant associations were revealed between the severity of pain syndrome and the level of the left ventricular ejection fraction and left ventricular mass index. Conclusion: The severity of pain syndrome caused by RA in patients with CHF can negatively affect some morphological and functional parameters of the myocardium, which must be taken into account when managing this group of patients.

Background: Suprascapular nerve neuropathy is a commonly spread pathology, caused by a traction force trauma or compression in the scapular notch area. In the case of a conservative treatment failure, a standard surgical procedure is neurolysis (decompression) of the suprascapular nerve in the scapular notch. This procedure can be done in an open manner or endoscopically. Aims: to evaluate the results of endoscopic decompression of the suprascapular nerve in the scapular notch area at a 6 months follow-up. Methods: We operated 10 patients with the clinical picture of posttraumatic suprascapular nerve neuropathy in the period from 2015 to 2021. The mean age of patients was 52.3±11.8. All the patients underwent the shoulder joint and subacromial space arthroscopy, and decompression of the suprascapular nerve in the scapular notch area. Results: According to the VAS-scale, the severity of pain syndrome before the surgery was 6 cm, while in 6 months after the surgery it decreased to 2 cm. According to the DASH scale, the dysfunction of the of shoulder joint before the surgery was 70 points, in 6 months after the surgery it decreased to 10 points. The range of motion in the shoulder joint before the surgery was: flexion 155±14,4°, abduction 140±42°, external rotation 12±5,6°; 6 months after the surgery we observed: flexion 174±15,6°, abduction 175±14,4°, external rotation 48±9°. Conclusion: The obtained results let us characterize the method of endoscopic decompression of the suprascapular nerve as a low-traumatic and effective technique, which promotes restoration of the function of the suprascapular nerve and shoulder joint, and elimination of pain syndrome from the shoulder area.

The COVID-19 pandemic is caused by the SARS-CoV-2 coronavirus. From the viewpoint of factors critical to contain the virus, the neutralizing antibodies to SARS-CoV-2 garner most of the attention, however, it is essential to acknowledge that it is the level of the virus-specific T cell and B cell response that forms a basis for an effective neutralizing antibody response. T cell responses develop early and correlate with the protection, but they are relatively attenuated in the severe disease, in part due to lymphopenia. Understanding the role of different T cell subpopulations in the protection or the COVID-19 pathogenesis is critical to the prevention and treatment. The expression profile of different T cell subpopulations varies with the COVID-19 severity and is associated with the degree of T cell responses and the disease outcome. The structural changes in the genome, transcriptome, and proteome of SARS-CoV-2 promote the emergence of new variants of the virus and can reduce its interaction with antibodies and result in avoiding the neutralization. There is a strong correlation between the number of virus-specific CD4 T cells and neutralizing IgG antibody titers against SARS-CoV-2. During the primary viral infection, there is a wide variation in the cellular and humoral immune responses, patients with severe and prolonged symptoms showing highly imbalanced cellular and humoral immune responses. This review focuses on the generation and clinical significance of cellular immunity in the protection against severe acute infection and reinfection, as well as the potential involvement of seasonal coronavirus-specific cross-reactive T cells in response to SARS-CoV-2.

Statins have long occupied a central place in cardiovascular medicine, being an integral component of the prevention and treatment of atherosclerotic cardiovascular diseases (coronary heart disease and its main clinical forms, angina pectoris and myocardial infarction; transient ischemic attacks, ischemic strokes, etc.). By blocking a key enzyme of cholesterol biosynthesis, 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA-reductase), statins normalize the parameters of the lipid spectrum, primarily, the serum levels of atherogenic low-density lipoprotein cholesterol. However, in addition to the beneficial effects of statins, side effects are also characteristic, which are a significant problem in modern clinical practice due to the fact that they can cause dangerous disorders, forcing physicians to reduce dosages or completely cancel these drugs. Understanding the side effects and the mechanisms underlying their formation is important for improving the measures for the early detection, prevention and treatment of those disorders. This article discusses such side effects of statins as myotoxicity, hepatotoxicity, nephrotoxicity. The pathogenetic mechanisms underlying these toxic effects of statins are discussed. A particular attention is paid to the effect of statins on the oxidative stress, the mechanisms of oxidative damage to cellular macromolecules (lipids, proteins and DNA) and their potential role in the development of myotoxicity, hepatotoxicity and nephrotoxicity.

Background: Among the modern methods of surgical treatment of the lumbar spine’s degenerative stenoses, decompressive-stabilizing surgical interventions using transpedicular screw-rod structures occupy an important place. The use of metal structures is justified not so much by the degenerative process specifics, degree or length of stenosis, but by the presence of instability in the spinal motion segments. In turn, the widespread use of fixing structures has naturally led to an increase in the specific complications, reaching 10–20 per cent of the total number of operated patients. One of the threatening complications of decompressive-stabilizing operations is the fracture of structural elements, often with the formation of pathology at the adjacent levels. The reasons for these complications are associated with both an erroneous choice of the construct parameters and a violation of the technique for installing the transpedicular fixation system (TPS). Clinical case description: The article presents an analysis of the clinical symptoms appearing with the formation of the adjacent level syndrome due to a fracture of the TPS system screws used to treat central stenosis of the spinal canal at the LIV -LV level. The correction of the pathology was carried out with a repeated surgical intervention. Conclusion: This clinical example draws attention to the combination of the adjacent level syndrome with a fracture of the metal structure in a patient after a decompressive-stabilizing operation using screw-rod fixation. An early diagnosis and adequate correction of the pathology helps to avoid the aggravation of symptoms and disability of patients.