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Vol 14, No 1 (2022)

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Clinical and genetic predictors of cardiovascular events as the risk of an unfavorable course and outcomes of novel coronavirus infection

Bratilova E.S., Kachnov V.A., Tyrenko V.V., Kolyubaeva S.N.


Numerous data indicate a high incidence of cardiovascular diseases against the background of a novel coronavirus infection, including initially healthy individuals. The development of complications such as cardiac rhythm disturbances, myocardial injury, acute coronary syndrome aggravates the severity of the disease and the prognosis. Moreover, signs of structural and functional damage of the cardiovascular system are detected after recovery, which makes prevention issues especially relevant. Various non-modifiable risk factors for the severe course of COVID-19, such as gender, age, heredity, race, environment, can determine the development of complications, including heart disease. In this matter, genetic characteristics are also important. The literature review presents possible genetic predictors and the mechanism of their influence on the development of cardiovascular complications and the severe course of novel coronavirus infection. The identification of specific genetic predictors can determine biological mechanisms that are relevant to diagnostic and treatment strategies. Moreover, recognizing people at high or low risk of severe COVID-19 can contribute to understanding the course of infection in different people and the development of cardiovascular complications. In addition, the determination of genetic markers contributes to the early detection of developing cardiovascular complications against the background of the novel coronavirus infection and elaboration of the personalized prevention strategy.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(1):5-16
pages 5-16 views

A modern view of the processes of mechanotransduction in healthy and damaged skin: review

Pavlenko I.V., Gostev V.N., Andriukhin K.V.


Questions concerning the study of mechanotransduction in the skin are currently of interest to many researchers, especially those engaged in the study of the problem of high-quality surgical treatment of soft tissue wounds. The possibility of developing new ways of treating various pathologies of the integumentary tissues, including wound defects, depends on understanding the processes of transmission and transformation of mechanical stimuli coming to skin cells into chains of biochemical reactions. The review presents the main historical stages of the development of scientific knowledge about mechanotransduction, describes the features of mechanotransduction in integumentary tissues, currently known mediators and signaling pathways that realize the transmission of mechanical influences from the cell surface to its nucleus, and also suggests possible directions for using this phenomenon in practice. The work also noted changes occurring at the cellular level during the “recoding” of mechanical signals in wounds prone to slowing down natural healing processes — chronic wounds. We believe that one of the promising trends in the practical application of mechanotransduction is the possibility of using its effects when stretching the skin during the treatment of wound defects of soft tissues.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(1):17-30
pages 17-30 views

The relationship between inflammatory bowel diseases and kidney diseases

Barysheva O.Y., Simanov R.N.


Inflammatory bowel diseases occupy a significant place among all diseases of the gastrointestinal tract. According to D. Corica, the prevalence of extra-intestinal manifestations in inflammatory bowel diseases ranges from 6 % to 46 %. Gastroenterologists are well aware of local intestinal manifestations of these diseases. The etiology of extra-intestinal manifestations is still unclear. However, it is well known that these injuries are not limited to the intestines and one of the target organs is the kidneys. The following review presents the analysis of possible pathogenetic mechanisms of intestinal and kidney lesions, such as Crohn’s disease, ulcerative colitis and urolithiasis, tubulointerstitial nephritis, glomerulonephritis and amyloidosis of the kidneys.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(1):31-38
pages 31-38 views

Digital healthcare in the Russian Federation: the current stage of transformation

Fil T.S.


The article presents the information about the current stage of digital transformation of the healthcare sector of the Russian Federation. The first part of the article presents the basic concepts and processes of the digital transformation, digital economy, digital rights, necessary for understanding the foundations of digital transformation in the healthcare sector. The article highlights the main laws and regulations on the process of digital transformation in the Russian Federation, technologies and services introduced mainly in the state healthcare system. The final part discusses the prospects and ethical problems of digital transformation. The article targets students, clinical residents, graduate students of medical universities, doctors and other healthcare professionals.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(1):39-50
pages 39-50 views

Original research

Depression, anxiety and asthenia in patients with comorbidity of chronic heart failure and iron deficiency

Smirnova M.P., Chizhov P.A., Baranov A.A.


BACKGROUND: A common comorbid pathology in patients with chronic heart failure is iron deficiency, as well as depressive and anxiety disorders.

AIM: To study the frequency and severity of depression, anxiety and asthenia in patients with heart failure and iron deficiency.

MATERIALS AND METHODS: 290 patients, 78 men and 212 women (mean age 71.29 ± 8.11 years) with chronic heart failure, functional class II–IV, have been examined. All the patients underwent clinical examination, a 6-minute walk test; a general blood test, the level of NT-proBNP, iron, transferrin, and ferritin in blood serum have been studied; the percentage of transferrin saturation with iron has been calculated. The presence of iron deficiency has been diagnosed on the basis of the following criteria: a decrease in the level of serum ferritin (less than 100 μg/L) or ferritin in the range from 100 to 299 μg/L and saturation of transferrin with iron less than 20 %. Hospital anxiety and depression scale (HADS) has been used to determine the presence and severity of depression and anxiety in points; the presence and severity of asthenia have been evaluated according to MFI-20 asthenia scale.

RESULTS: It has been found that in patients with chronic heart failure and iron deficiency, depression and anxiety are diagnosed significantly more often than in patients without iron deficiency. In addition, in patients with iron deficiency, the severity of depression, anxiety and various manifestations of asthenia are significantly greater.

CONCLUSIONS: In chronic heart failure, iron deficiency predisposes patients to the development of depression and anxiety and an increase in various manifestations of asthenia.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(1):51-58
pages 51-58 views

Anti-inflammatory therapy for COVID-19: effectiveness and predictors of response

Sukhomlinova I.M., Bakulin I.G., Kabanov M.Y.


BACKGROUND: According to the international guidelines and expert opinions, medicines for the treatment of COVID-19 are prescribed off-label; however, the final decision is made by a physician based on an assessment of the risk/benefit ratio for each patient. Global studies of the efficacy and safety of the use of baricitinib, tocilizumab, olokizumab, dexamethasone in the treatment of COVID-19 are ongoing. There is no information about comparative efficacy of these drugs and on the prognosis of their use in COVID-19.

AIM: To compare the effects of pre-emptive anti-inflammatory therapy (PAT) with tocilizumab, olokizumab, baricitinib, dexamethasone in patients with COVID-19 to identify response predictors and the choice of the most effective treatment.

MATERIALS AND METHODS: A retrospective analysis of 229 cases of severe and moderate course of COVID-19 requiring various types of UPT at the Hospital for War Veterans has been carried out.

RESULTS: In the study of 229 clinical cases of severe COVID-19, it was found that the most significant predictors of the effects of anticytokine therapy include C-reactive protein (CRP), body mass index (BMI), body temperature, saturation level and the need for a certain type of oxygen support at the start of a therapy, platelet count, hematocrit, neutrophil count, and duration of the disease from its onset to development of signs of a cytokine storm. The probability of recovery in the patients with early appointment of UPT increases by 13%; the need for additional oxygen support increases the risk of mortality by 5.3 times as it increases with the transition to each subsequent level; an increase in the level of CRP by 1% increases the unfavorable prognosis; an increase in D-dimer worsens the prognosis by 16%.

CONCLUSION: Based on the statistical data obtained by the method of stepwise regression analysis, was proposed method for predicting the effectiveness of proactive anti-inflammatory therapy in novel coronavirus infections.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(1):59-68
pages 59-68 views

Influence of risk factors for the development of cardiovascular diseases on the parameters of arterial stiffness in patients with arterial hypertension and atherosclerosis of different degrees of severity

Sayganov S.A., Gumerova V.E., Gomonova V.V.


BACKGROUND: Arterial hypertension is widespread in the population, leads to the development of arteriosclerosis and increase of arterial stiffness, and is the main non-lipid risk factor of atherosclerosis development. Multiple studies have shown that increase of arterial stiffness is an independent risk factor for the development of cardiovascular events. However, the influence of traditional cardiovascular risk factors on arterial stiffness in arterial hypertension and atherosclerotic process of different degrees of severity has not been sufficiently studied.

AIM: To assess the influence of traditional risk factors on the parameters of arterial stiffness in patients with arterial hypertension (AH) and atherosclerotic process of varying degrees of severity.

MATERIALS AND METHODS: 133 subjects with AH have been divided into 3 groups depending on the severity of the atherosclerotic process. The control group included 33 individuals without known cardiovascular diseases. All the participants have undergone a standard clinical and laboratory examination, 24hr blood pressure monitoring with assessment of arterial stiffness (AS) parameters. The influence of risk factors on AS parameters has been analyzed for all the participants and separately by groups.

RESULTS: In the AH patients, an increase in the arterial stiffness index (ASI) is associated with an older age and an increase in systolic blood pressure (SBP); an increase in the augmentation index (AIx75) is associated with age; SBP in higher in women. Pulse wave velocity in the aorta (PWVao) is most associated with age, smoking, and family history in patients with hypertension and subclinical atherosclerosis. An increase in AIx75 is associated with an older age and is higher in women, while ASI has a positive relationship with age and SBP. In patients with hypertension and coronary artery disease, there is a positive correlation between male body mass index and PWVao. The increase in ASI in this group is associated with female gender, SBP and age. In individuals without hypertension and signs of atherosclerosis with a family history of CVD, PWVao values are higher than in similar individuals without a family history of CVD.

CONCLUSIONS: In the group of all the participants, female gender, smoking, an older age, SBP, and body mass index are associated with increased AS parameters. The association between risk factors and parameters of arterial stiffness has peculiarities in patients with hypertension with varying degrees of severity of the atherosclerotic process.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(1):69-76
pages 69-76 views

The use of E. faecium probiotic and autoprobiotic in patients with type 2 diabetes mellitus

Bakulina N.V., Tikhonov S.V., Ermolenko E.I., Kotyleva M.P., Lavrenova N.S., Topalova Y.G., Simanenkov V.I., Suvorov A.N.


BACKGROUND: Bacteria in the gastrointestinal tract regulate eating behavior and metabolic processes. A number of probiotic strains have a positive effect on glucose and insulin metabolism. A series of studies have demonstrated the effectiveness of autoprobiotic therapy in the treatment of patients with gastrointestinal diseases. The efficacy and safety of an indigenous strain of Enterococcus faecium in overweight patients with type 2 diabetes has not been studied in the past.

AIM: To evaluate the effectiveness of products containing the probiotic strain Enterococcus faecium L3 or the indigenous strain Enterococcus faecium in patients with diabetes mellitus (DM) type 2.

MATERIALS AND METHODS: Patients with diabetes mellitus type 2 were randomized into two groups: group of probiotic therapy with an industrial strain of Enterococcus faecium L3 (11 patients); group of autoprobiotic therapy based on an indigenous strain of Enterococcus faecium (9 patients). Therapy was for 14 days. Before and 10-14 days after the end of therapy, anthropometric parameters were assessed; psychometric testing was carried out; biochemical parameters of blood serum were studied. The intestinal microbiota was studied by real-time polymerase chain reaction.

RESULTS: Probiotic therapy based on Enterococcus faecium L3 and autoprobiotic therapy based on indigenous Enterococcus faecium had no significant effect on glucose metabolism in patients with type 2 DM. In the Enterococcus faecium L3 group and the group of indigenous Enterococcus faecium there was a significant decrease in gastroenterological complaints on scales of the GSRS questionnaire. Patients in both groups showed a statistically significant decrease in the total bacterial mass, an increase in the quantitative content of Lactobacillus spp., a decrease in the population of Bifidobacterium spp. and Bacteroides thetaiotaomicron.

CONCLUSIONS: The probiotic strain Enterococcus faecium L3 and the indigenous Enterococcus faecium do not have a significant effect on the metabolism of glucose and insulin, while they contribute to a similar change in the component composition of the microbiota and a decrease in the severity of gastroenterological complaints.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(1):77-88
pages 77-88 views

Inadequate rehabilitation after multi-level revascularization as a risk factor of low quality of life

Glushkov N.I., Puzdriak P.D., Ivanov M.A., Chizhova K.A., Agurbash A.N.


BACKGROUND: Reconstructive surgery of multilevel lesions in peripheral atherosclerosis has been undergoing changes over the past decades. The spectrum of such interventions includes conventional, endovascular and hybrid technologies. Due to the fact that the main goal of treatment is to preserve the limb, the outcome of the surgical intervention directly affects the quality of patients’ life; however, there is insufficient data in the literature on the tactics of postoperative rehabilitation of patients who underwent surgery for a multilevel lesion. Randomized clinical trials aimed at studying the effectiveness of walk training and rehabilitation measures demonstrate an increase in walking distance in people with peripheral atherosclerosis against the background of controlled physical exertion.

АIM: To assess the effect of rehabilitation program on the vital activity levels in the patients who suffered from multilevel peripheral arterial disease in a long-term period after revascularization.

MATERIALS AND METHODS: The study included 216 patients with MPAD who underwent various lower limb revascularization, including 87 patients with hybrid interventions, 81 – open surgery and 48 with endovascular interventions. The patients have been examined both in perioperative and postoperative periods as well as in a long-term period (36 months) after reconstruction. Depending on the fulfillment or non-fulfillment of the proposed rehabilitation program, such indicators as limb preservation, walking distance and quality of patient’s life have been evaluated in accordance with the EQ-5D questionnaire.

RESULTS: In the early postoperative period, a decrease in the number of thrombosis of the operated segment has been registered in the group of hybrid interventions in comparison with the results in the group with open operations. In the long-term period after the operation, the use of complex rehabilitation measures allowed to reduce the number of amputations and stabilize the maximum walking distance. Walk training provided the necessary level of quality of life, which, in most cases, has been recorded in the patients who underwent hybrid interventions.

CONCLUSIONS: The composition and fullness of rehabilitation program is a circumstance affecting long-term outcomes after reconstructive vascular interventions. The exclusion of walk training from the rehabilitation program does not allow achieving the maximum frequency of limb preservation, increasing the walking distance and improving the quality of life of patients suffering from multilevel lesion of the arteries of the lower extremities.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(1):89-96
pages 89-96 views

Case report

Liver injury and novel coronavirus infection: development mechanisms and clinical manifestation

Livzan M.A., Gaus O.V., Gavrilenko D.A.


The novel coronavirus infection (COVID-19) caused by SARS-CoV-2 is characterized by a variety of clinical manifestations. As the infection spreads and the number of observations increases, it is clear that SARS-CoV-2 affects not only the respiratory tract, but also the digestive system. More than half of patients with COVID-19 have changes in the biochemical blood test, indicating liver damage. The reasons for this may be direct cytopathic or mediated immune effect, organ ischemia, the intake of drugs with potential hepatotoxic effects, onset of previously undiagnosed or worsening of the course of an existing liver disease. This article provides a brief overview of the possible etiological factors of liver damage in COVID-19 and presents its own clinical case.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(1):97-104
pages 97-104 views

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