[V. N. Vinogradov Faculty Therapy Clinic of Sechenov University: the flagship of the therapeutic service of the Russian Federation. A review]

The history of the Faculty Therapy Clinic of Sechenov University is presented. The stages of the formation of its therapeutic school are discussed. Diagnostic and therapeutic methods first developed and implemented in the clinic are described in detail.

[Computed tomography in cardiology: history and perspectives]

The review article highlights the main stages of the formation of computed tomography (CT) as a key method used in modern cardiology. The progress of CT scanners is directly related to the increase in the number of detectors, and thus, with an increase in the number of simultaneously collected projections. Modern developments and future technologies in the field of further development of the technique, including CT angiography and other new methods for assessing coronary blood flow, are discussed. The use of artificial intelligence technologies may make it possible to improve and accelerate the interpretation of the resulting images in the future, especially if it is economically justified.

[Relationship between the pain severity, use of non-steroidal anti-inflammatory drugs and blood pressure in elective large joint arthroplasty of the lower extremities]

AIM

To evaluate the changes in blood pressure (BP), the severity of pain syndrome and non-steroidal anti-inflammatory drugs (NSAIDs) use patterns in patients hospitalized for elective arthroplasty of large joints of the lower extremities during the postoperative period.

MATERIALS AND METHODS

This study included 374 patients. In all patients, medical history, antihypertensive therapy and history of NSAIDs usage were collected, BP was measured, and the severity of pain was assessed via a 10-point scale before surgery, as well as 1 and 3 months after arthroplasty.

RESULTS

The study included 132 (35.3%) males and 242 (64.7%) females. Among these, 289 (77.3%) patients had hypertension [grade 1 - 35 patients, grade 2 - 136 patients, grade 3 - 118 (25.0%) patients]; 280 (74.9%) patients were taking NSAIDs (121 - daily, 135 - 2-3 times per week). The median pain severity before surgery was 8 points [7; 9], 1 month after surgery - 2 points [1; 4], 3 months after surgery - 1 point [0; 3]. At 1 month after arthroplasty, 23 (7.9%) patients reported a decrease in BP. In 17 (5.9%) patients, correction of previously prescribed antihypertensive therapy with a decrease in drug doses was required. At 1 month after arthroplasty, 256 patients discontinued NSAIDs. The analysis of the relationship between the severity of pain, NSAIDs use and the level of BP revealed a significant effect of pain syndrome (p<0.0001) and the use of NSAIDs (p=0.014).

CONCLUSION

In the population of patients with elective arthroplasty of large joints of the lower extremities, a significant incidence of hypertension and a high prevalence of NSAIDs use are noted. During the postoperative period, a significant trend towards a decrease in the severity of pain was found, as well as the relationship of pain and NSAIDs with a decrease in BP.

[The survival prediction of hospitalized patients with COVID-19: the role of chitotriosidase level in peripheral blood]

AIM

To assess the relationship between plasma chitotiosidase (CHIT) level and mortality in hospitalized patients with COVID-19.

MATERIALS AND METHODS

347 hospitalized patients with COVID-19 were enrolled in our single-center cohort prospective observational study. On the first day of hospitalization the patients were assessed by the level of CHIT in the venosus blood to addition to default laboratory examinations. The primary endpoint was all-cause death. The survival after hospital discharge were assessed via phone calls on 90 and 180 days since inclusion to the study (NCT04752085).

RESULTS

Our study included 347 patients. The first symptoms appeared in 7 days [5; 7] before hospitalization; 283 (84.3%) patients had less than 50% of the involvement of the lung tissue to the inflammation process (CT 0-2); 36 (10.4%) patients had died since the start of our investigation; 30 (83.3%) of them died during hospitalization, others -no later than 60 days; 68 (19%) people didn't answer during phone call. The survivor's activity of the enzyme in the deceased was significantly lower in compare to deceased patients (90.5 [40.2; 178.0] nmol/h/mL vs 180.0 [77.2; 393.2] nmol/h/mL; p=0.001). Survivor of the patients with a higher level of the activity of the CHIT (more than 171 nmol/h/mL) was statically significantly lower.

CONCLUSION

Rising of the CHIT's activity more than 171 nmol/h/mL might be an early independent predictor of the bad prognosis of the patients, who were hospitalized with COVID-19 infection.

[Urolithiasis in HIV-positive patients: prevalence and risk factors]

Today, the total number of people living with the human immunodeficiency virus (HIV) is 43.8 million. From the moment of infection to the terminal stage of the disease, the risk of stone formation progressively increases. A prevalence and role of individual risk factors for urolithiasis in patients with HIV are reviewed in the article. It is shown that in HIV-positive individuals, urolithiasis takes a leading position among renal diseases, with a prevalence ranging from 8 to 27%. The main risk factors for urolithiasis in HIV are: dietary factors, age, comorbid pathologies, use of protease inhibitors, changes in the ionic composition of urine, etc.

[Prevalence, age and gender features of chronic kidney disease in patients with diabetes mellitus]

AIM

To study the prevalence, age and gender characteristics of chronic kidney disease (CKD) in patients with diabetes mellitus (DM).

MATERIALS AND METHODS

In a case-control study, clinical and laboratory data were analyzed in 683 patients with DM (4.6% of patients with type 1 DM and 95.4% with type 2 DM) and kidney damage. The indicators of anthropometry, hemodynamics and biochemistry were studied. The glomerular filtration rate (GFR) was calculated using the CKD-EPI formula.

RESULTS

The proportion of middle-aged and elderly patients with CKD was the most numerous, amounting to 39 and 38%, respectively. At the same time, anemia was more common in young people, and hypercholesterolemia (35.0%), proteinuria (47.5%) and signs of renal failure (45.0%) - in middle-aged patients with CKD. 47.0% study participants had C1 and C2 categories of changes in renal function. Mean levels of systolic blood pressure (BP), the prevalence of proteinuria were statistically significantly higher in women. When evaluating the correlations, we found statistically significant relationships between the calculated GFR and the level of body mass index, systolic BP, venous blood glucose and Hb in the subgroup of men. Among females, a significant relationship between the calculated GFR value was revealed with indicators of systolic and diastolic BP, venous blood glucose and Hb concentration.

CONCLUSION

Our data indicate the existence of differences in the prevalence of CKD and associated risk factors for the progression of renal failure, depending on gender differences and living conditions of patients. In urban residents, CKD was most often associated with arterial hypertension and renal failure, while overweight, obesity, and proteinuria were significantly more common in rural areas. The incidence of proteinuria and mean levels of systolic BP were significantly higher in females. Further study of the issue under discussion seems promising from the standpoint of a personalized approach and the search for a new preventive strategy to combat both end-stage renal failure and its complications.

[Modern methods of assessment of physiological significance of coronary lesions: A review]

The article describes the main methods of assessment of physiological significance of coronary artery stenoses, their use in clinical practice and future perspectives. New diagnostic methods that are currently under research are discussed.

[Contrast-enhanced ultrasound: history, application and perspectives]

The article discusses the stages of formation and development of ultrasound diagnostics, including those with contrast enhancement. The main types of contrast agents and their mechanism of action are presented. Examples of the use of contrast-enhanced ultrasound in various fields of medicine are given. The prospects of the method and its place in clinical practice are discussed.

[Anemia and quality of life of chronic kidney disease patients on renal replacement therapy by programmed hemodialysis]

AIM

To study relationship between anemia and health-related quality of life (HRQOL) of chronic kidney disease stage 5 patients (CKD) undergoing renal replacement therapy by programmed hemodialysis.

MATERIALS AND METHODS

The study was conducted on the basis of dialysis centers/departments in Moscow. The Russian-language version of the KDQOL-SF^TM questionnaire, validated in Russia, was used to assess the HRQOL of patients on hemodialysis. A total of 723 patients were interviewed. Hemoglobin (Hb) levels were assessed in 442 patients based on outpatient records. To identify the relationship between Hb level and HRQOL scales, a correlation analysis was performed, as well as a HRQOL analysis in the three groups differing in hemoglobin levels (<100; 100-120 and >120 g/l). Statistical data processing was carried by SPSS.22 and using parametric and nonparametric statistical methods.

RESULTS

Correlation relationship was revealed between Hb and HRQOL of patients on hemodialysis on the scales "symptoms/problems", "pain", "vital activity, energy" and "total physical component of health". According to the scales "symptoms/problems" and "vital activity, energy", higher rates were noted among patients with Hb higher than the target level, which confirms the recommendations concerning the possibility of achieving higher Hb among individual patients who have not serious concomitant diseases and cardiovascular complications in order to improve their quality of life.

CONCLUSION

HRQOL assessment is important tool for planning and evaluating the effectiveness of anemia drug therapy among patients with CKD on hemodialysis.

[Vascular endothelial growth factor in elderly and senile age: clinical and pathogenetic relationships.]

The aim of the study was to study the role of serum vascular endothelial growth factor and to determine its clinical significance in elderly and senile patients. The study included 124 people (40 men and 84 women) aged 60 to 89 years, the average age was 68,8±7,4 years. Serum levels of vascular endothelial growth factor (VEGF) were studied in the work; blood lipid spectrum parameters, indicators of acute phase blood proteins: C-reactive protein (C-RP), fibrinogen; glomerular filtration rate (GFR) according to the CKD-EPI formula based on serum creatinine and according to the F. Hoek method using cystatin C. In general, 15,3% of the examined individuals had elevated serum levels of VEGF, more often in elderly patients. It was found that serum levels of VEGF are positively associated with the concentration of CRP (r=0,411), the number of platelets in peripheral blood (r=0,358) and positive with the concentration of serum cystatin C (r=0,211). In the subgroup of patients with an elevated serum VEGF level, the platelet count, the concentration of C-RP, fibrinogen, and cystatin C were significantly higher, and the calculated GFR according to F.Hoek was significantly lower. Patients with an elevated serum VEGF level, as a pro-inflammatory and prothrombogenic potential, especially if it is associated with the development of kidney dysfunction in the elderly and senile, should be considered as a risk group for atherothrombotic cardiovascular events.

[New data on the pathophysiology of ischemic stroke: epigenetic mechanisms in focus]

Epigenetics is a branch of molecular biology that studies modifications able to change gene expression without changing the DNA sequence. Epigenetic modulations include DNA methylation, histone modifications, and noncoding RNAs. These heritable and modifiable gene changes can be caused by lifestyle and dietary factors. In recent years, epigenetic changes have been associated with the pathogenesis of a number of diseases, such as diabetes mellitus, obesity, renal pathology and various types of cancer. They were also associated with the pathogenesis of cardiovascular diseases, including ischemic stroke. In this regard, it is important to note that since epigenetic modifications are reversible processes, they can help in the development of new therapeutic approaches to treat human diseases. This mini-review presents the latest data on the influence of epigenetic modifications on the pathogenesis of ischemic stroke obtained both in animal models and in patients.

[Chronic cerebral ischemia in therapeutic hospital patients]

OBJECTIVE

To study the features of clinical and functional manifestations of the syndrome of chronic cerebral ischemia (CCI) in therapeutic patients.

MATERIAL AND METHODS

Patients (n=577) in therapeutic departments were selected by random sampling. Of these, 277 patients had verified CCI.

RESULTS

Patients with CCI, compared with the control group, were older (61.7±9.6 years and 43.3±12.2 years, p<0.05), had a significant increase in body mass index (28.5±5.1 and 26.9±5.7 kg/m², p<0.05), systolic level (140±20 and 127±17 mmHg, p<0.05) and diastolic blood pressure (87±10 and 82±11 mm Hg, p<0.05), platelet count in peripheral blood (278.0±70.7·10⁹/l and 259.1±80.8·10⁹/l, p<0.05), venous blood glucose (7.11±3.8 and 5.31±1.7 mmol/l, p<0.05), triglycerides (1.37 (1.01; 1.97) mmol/l and 1.34 (0.96; 1.96) mmol/l, p<0.05), uric acid (0.425±0.12 and 0.374±0.14 mmol/l, p<0.05), creatinine (82.7 (68.0; 114.0) µmol/l and 72.3 (61.8; 93.0) µmol/l, p<0.05) and cystatin C (1.24 (1.08;1.62) mg/l and 1.01 (0.87; 1.32) mg/l, p<0.05). Statistically significant decrease in the concentration of high-density lipoprotein cholesterol (1.0±0.28 mmol/l and 1.2±0.32 mmol/l, p<0.05), serum magnesium (0.90±0.15 and 0.94±0.13 mmol/l, p<0.05) and estimated GFR (57.9±24 and 72.6±26.8 ml/min, p<0.05) were characteristic of patients with CCI. Elevated levels of C-reactive protein and anemia were significantly more common in these patients. A close correlation was found between the concentrations of uric acid (r=0.786; p<0.001) and cystatin C (r=0.587; p<0.005) in blood serum and the thickness of the intima-media complex of the carotid arteries.

CONCLUSION

In patients of a therapeutic hospital, CCI is associated with older age, weight gain, arterial hypertension, dyslipidemia, anemia, inflammation, hypomagnesemia, hyperuricemia, thickening of the intima-media complex of the carotid arteries, and a decrease in the functional state of the kidneys.

Contrast-associated acute kidney injury after percutaneous coronary interventions in patients with acute coronary syndrome: a real-world study

Aim. To study the incidence of contrast-associated acute kidney injury (CA-AKI) in patients with various forms of the acute coronary syndrome (ACS). Materials and methods. An observational, open, single-center, prospective study included 83 patients with ACS with indications for percutaneous coronary intervention. Of these, 40 were included in the ST-segment elevation ACS group, and 43 patients were included in the non-ST-segment elevation ACS group. The study is registered at ClinicalTrials.gov as NCT04163484. Before the intervention, all patients had a general examination, ECG, complete blood count, blood chemistry, and blood coagulation tests. Later, 24 and 48 hours after the intervention, the serum creatinine (SC) trend was assessed. The primary endpoint was the development of in-hospital CA-AKI according to KDIGO criteria within 72 h or before hospital discharge. Results. An increase in SC level by 25% from the baseline was observed in 6 patients in each subgroup of ACS. A marked increase in SC by 50% and a decrease in glomerular filtration rate were reported only in 2 patients (one in each subgroup of ACS). Conclusion. The study showed that the incidence of CA-AKI in patients with ACS with ST-segment elevation was 2.3%, and in the group of patients with ACS without ST-segment elevation 2.5%.

Anatomy of the coronary arteries and localization of coronary atherosclerosis in siblings with coronary heart disease

There is no doubt that there is a similar genetic predisposition in close relatives to the development of cardiovascular disease, while the features of coronary anatomy and possible commonality of pathological process in close relatives remain beyond research interest. Aim. To study the anatomy of the coronary arteries, the nature and severity of coronary lesion in pairs of male siblings suffering from coronary artery disease, in comparison with control pairs of patients who are not closely related. Materials and methods. This retrospective study included 87 male patients. The main group (58 patients or 29 couples) consisted of siblings with a horizontal hereditary burden for coronary artery disease. The control subgroup included 29 big brothers of the main group and another 29 patients who unrelated to them. To assess the degree of anatomy identity of the coronary bed in pairs of patients, we used a comparative characteristic of 25 segments of the coronary arteries (SyntaxScore). If there was similarity in anatomy and in the severity of the atherosclerotic process, each segment was assigned one point. In terms of the ratio of the total scores to the total number of segments (n=25), each pair of patients was assigned anatomical and atherosclerotic identity indexes. Results. According to the results of the study, the average indices of anatomical and atherosclerotic identity indexes were significantly higher in pairs of sibs compared to control pairs of patients (0.92 versus 0.88, p=0.008 and 0.92 versus 0.76, p0.001 respectively). When analyzing atherosclerotic lesions of the coronary arteries in pairs of sibs, a statistically significant coincidence of lesions in a number of segments of the coronary arteries was revealed, with the highest agreement in the left main coronary artery (=0.869, p0.001) and in the proximal segments of the main branches of the coronary arteries: left anterior descending artery (=0.786, p0.001) and right coronary artery (=0.812, p0.001). In the group of control pairs, such regularities were not revealed. Conclusion. In siblings with horizontal hereditary burden for coronary artery disease along the sibling line, the average anatomical and atherosclerotic identity indexes are significantly higher compared to control pairs. In pairs of siblings, there is the highest and most reliable probability of developing coronary atherosclerosis in the left main coronary artery and in the proximal segments of the left anterior descending artery and right coronary artery.

Optimization of blood pressure control in patients with resistant arterial hypertension and visceral obesity

Aim. To evaluate the course of resistant arterial hypertension in patients with visceral obesity, to identify predictors of unsatisfactory shot-term and long-term treatment outcomes, to optimize therapy and improve adherence to treatment. Materials and methods. A total number of 90 individuals with a history of refractory or resistant arterial hypertension and visceral obesity were a subject of intensive study. The prospective analysis group consisted of 30 patients with an individualized management plan each, whereas the retrospective group of real clinical practice included 60 participants. At baseline, all patients were taking antihypertensives like ACE inhibitors or angiotensin II receptor blockers (ARBs)/angiotensin-converting enzyme inhibitors, calcium channel blockers (CCBs), and a diuretic. After the initial examination, therapy was individually optimized for each patient in accordance with current clinical guidelines. Most patients in the retrospective group received ARBs valsartan or losartan, CCBs amlodipine, the diuretics indapamide and torasemide, the -blockers bisoprolol and metoprolol, the 2-agonist moxonidine, and the mineralocorticoid receptor antagonist spironolactone. Patients in the prospective group were prescribed ARBs telmisartan and azilsartan, the CCB lercanidipine, thiazide and thiazide-like diuretics indapamide and chlorthalidone, the -blockers nebivolol and carvedilol, the 1-blocker doxazosin, and spironolactone. A re-examination was performed 2 months later. Subsequently, regular communication was maintained with participants of the prospective group during 8 months using a messenger. Communication with patients of the retrospective group was not maintained. All the patients were then asked to self-report their health status by conducting a telephone survey. Results. After 2 months, according to the data of the follow-up, in the retrospective group the target values of mean daily SBP and DBP were observed in 35 and 36.7% of patients, though the statistics among the patients in the prospective group were 66.7 and 60%, respectively. After 10 months, according to the results of the interviews, the target values of SBP and DBP were observed in 10 and 18.3% of patients, though the statistics among the patients in the prospective group were 93.3 and 96.7%, respectively. In the retrospective group, 78.3% of patients changed the previously selected therapy, in the prospective group this figure was only 20%. In the retrospective group, anthropometric data did not change, while in the prospective group, weight and waist circumference significantly decreased (p0.05). Conclusion. Maintaining regular contact with patients and a well-rounded treatment strategy with individualized choice and dosage of medications with an emphasis on modern metabolically neutral drugs with a prolonged duration of action led to better BP control, increased adherence to therapy and indicated significant weight loss among the patients from the prospective group.

The prevalence of hypertension among patients with psoriasis in clinical practice

Background. Psoriasis is a systemic chronic immune-mediated inflammatory skin disease of a multifactorial nature that affects about 2 to 3% of the population worldwide. Given the systemic nature of the disease, the level of comorbid diseases is high, especially those associated with damage to the cardiovascular system. According to the results of various meta-analyzes, it has been proven that among patients with psoriasis, the risk of developing hypertension is high. Aim. To evaluate the prevalence of arterial hypertension (AH) among patients with psoriasis. Materials and methods. We present an open, prospective, observational clinical trial, which includes 60 patients diagnosed with psoriasis vulgaris of varying severity and psoriatic arthritis. All patients underwent clinical and laboratory tests, including the level of total cholesterol, glucose, creatinine, C-reactive protein, calculation of glomerular filtration rate. Body mass index, blood pressure level according to the Korotkov method, severity of the disease by determining psoriasis area and severity Index (PASI), dermatological quality of life index (DLQI), levels of hospital anxiety and depression according to the HADS scale were also assessed. The SCORE2 scale was used to assess cardiovascular risk in patients aged 40 to 69 years, the SCORE 2OP scale for patients aged 70 to 89 years, respectively. Cardiovascular risk was defined as low for patients under 40 years of age. All study participants were examined for the presence of AH. Results. The prevalence of hypertension was 25%, with prevalence among men (15%). The prevalence of hypertension is directly proportional to the severity of psoriasis (13% with hypertension in patients with severe psoriasis, 12% with hypertension with moderate psoriasis, 2% with hypertension with mild psoriasis). Conclusion. Given the high prevalence of AH among patients with psoriasis, it is necessary to form a multidisciplinary approach to the treatment of patients, including a thorough assessment of cardiovascular risk in clinical practice.

[The atorvastatin effects on the prevention of contrast-induced acute kidney injury during computed tomography with contrast media]

AIM

To assess the role of atorvastatin to the frequency of contrast-induced acute kidney injury (CI-AKI) in patients with cardiovascular diseases (CVD) undergoing computed tomography (CT) with intravenous contrast media.

MATERIALS AND METHODS

One hundred patients with CVD undergoing CT with with intravenous contrast media administration were included in prospective observational study (ClinicalTrials.gov ID NCT04666389). Patients were divided into 3 groups 16 (15.8%) patients receiving atorvastatin at a dose of 80 mg 24 hours and 40 mg before the CT and 40 mg after; 33 (32.7%) patients 40 mg before the CT and 40 mg after; 52 (51.5%) people not receiving statin therapy. The primary endpoint was CI-AKI according to KDIGO criteria: the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 4872 hours after administration of contrast media. There were 51% of men. The average age was 59.7714.4. The most frequent cardiovascular disease was hypertension 86%.

RESULTS

CI-AKI was diagnosed in 4 (3.96%) patients. At the same time, it was not possible to establish statistically significant relationships (p0.05) between risk factors and the development of CI-AKI. Statins can be a successful way to prevent this complication.

CONCLUSION

Cardiovascular diseases may increase the risk of CI-AKI after computed tomography with intravenous contrast media administration. Therefore, it is recommended to evaluate the serum creatinine concentration in such patients.

[Functional state of kidneys and cardiovascular risk in patients with urolithiasis in an outpatient setting]

AIM

To analyze the functional state of the kidneys and vascular stiffness in patients with urinary stone disease in an outpatient setting.

MATERIAL AND METHODS

A total of 110 patients with urinary stone disease aged 17-72 years were included in the study. The stone size was 2,67 (1,90-3,49) mm. A clinical examination included evaluation of vascular stiffness, serum level of creatinine, cystatin C, calcium, phosphorus, sodium, magnesium, uric acid and total cholesterol. The glomerular filtration rate (eGFR) was calculated based on the formulas CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) and MDRD (Modification of Diet in Renal Disease) and Hoek's equations using creatinine and cystatin C, respectively.

RESULTS

Most often, urinary stone disease was associated with arterial hypertension (75%), a sedentary lifestyle (66.3%), hypercholesterolemia (53.6%), obesity (47.2%), hyperuricemia (44.5%) and smoking (40.9%). The median and interquartile range of eGFR according to CKD-EPI, MDRD and Hoek's equations was 100.00 (78.00;113.00) ml/min, 96.00 (71.00;106.00) ml/min and 77.65 (61.50; 93.60) ml/min, respectively. The normal GFR was significantly more often detected by the formula CKD-EPI (66.3%) in comparison with the Hoek's equations (52.7%), p<0.05. A decrease in mild GFR was found in 21 (19.0%) patients according to CKD-EPI and 33 (30.0%) according to Hoek's equations (p<0.05). In the subgroup of patients with a mild to moderate decrease in GFR according to the Hoek's equations, stiffness index and resistive index were significantly higher than in the similar subgroup of patients with decrease of GFR measured using the CKD-EPI formula (p<0.05). A negative correlation between GFR calculated using three formulas and Augmentation Index was established.

CONCLUSIONS

In patients with urinary stone disease, potential cardiovascular risk factors are very common. The study of serum cystatin C level with calculation of GFR according to Hoek's equations in individuals with urolithiasis allows to evaluate total renal nitrogen excretion, as well as the level of the cardiovascular risk in the early stages of the disease.

[Modern biomarkers of renal dysfunction in the elderly and senile age: clinical and prognostic significance.]

In the presented work, the role of modern biomarkers of kidney dysfunction in elderly (n=97) and senile (n=18) patients was investigated. A clinical and laboratory examination was performed with an assessment of the glomerular filtration rate (GFR) using the CKD-EPI formula. Serum levels of cystatin C and metabolism of beta-2-microglobulin (β2-MG) were assessed. In the presented sample, the prevalence of a decrease in GFR <60 ml/min was 30,4% of cases. The frequency of individuals with elevated serum cystatin C, depending on the GFR category (CKD-EPI), was as follows: C1 - in 79,9%; C2 - in 77,6%; C3A - in 74%; C3B - in 80,6%; C4 - in 100%; C5 - in 100%. An increase in the serum level of β2-MG was observed in 51,8 and 58,4% of patients, respectively, on C1 and C2 gradations of renal function. An increase in urinary β2-MG excretion was found in 40,7% of patients at C1 and 41,5% at C2 gradations of renal function. The number of patients who had elevated levels of β2-MG excretion in the urine at C3B and C4 gradations of GFR reduction was 75 and 88,6%, respectively. At the terminal stage of CKD, almost every patient showed an increase in β2-MG excretion in the urine. A statistically significant relationship between the metabolism of β2-MG and the nitrogen excretion function of the kidneys was established. In elderly and senile people, the determination of serum levels of cystatin C and β2-MG makes it possible to detect a decrease in the filtration function of the kidneys at an earlier stage compared with the assessment of GFR calculated from the level of blood creatinine. Elevated levels of cystatin C and β2-MG are additional risk factors for cardiovascular complications.

[Adenocarcinoma of the lung against the background of usual interstitial pneumonia]

Lung adenocarcinoma against the background of idiopathic pulmonary fibrosis according to the world literature ranges from 2.7% to 48%, the incidence increases every year after the diagnosis of idiopathic pulmonary fibrosis. We present a clinical and morphological analysis of an autopsy observation of lung adenocarcinoma that developed against the background of corticosteroid-treated usual interstitial pneumonia in a 78-year-old woman. According to the results of histological and immunohistochemical studies, the diagnosis was formulated as: multicentric non-mucinous invasive adenocarcinoma of the right and left lungs with a lepidic growth pattern with background of usual interstitial pneumonia.

Contrast-induced acute kidney injury after computed tomography with contrast media in patients with cardiovascular diseases

Aim. To assess the frequency of contrast-induced acute kidney injury (CI-AKI) in patients with cardiovascular diseases (CVD) undergoing computed tomography (CT) with intravenous contrast media. Materials and methods. In prospective observational study (ClinicalTrials.gov ID NCT04666389) were included 51 patients with CVD undergoing CT with intravenous contrast media administration. The primary endpoint was CI-AKI according to KDIGO criteria [the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 4872 hours after administration of contrast media]. There were 51% of women included in the study. The average age was 61.741.5. The most frequent cardiovascular disease was hypertension in both men and women 52 and 39% respectively. Results. CI-AKI was diagnosed in 2 (3.92%) patients. At the same time, it was not possible to establish statistically significant relationship (p0.05) between risk factors and the development of CI-AKI. Conclusion. Cardiovascular diseases may increase the risk of CI-AKI after CT with intravenous contrast media administration. Therefore, it is recommended to evaluate the serum creatinine concentration in such patients.

The female gender as a risk factor of contrast-induced acute kidney injury in patients with chronic coronary syndromes

Background

The female gender is a well known risk factor of acute kidney injury that is included in many score widely used by cardiologists for assessment of the risk of contrast-induced acute kidney injury (CI-AKI). The exact influence of gender in patients with chronic coronary syndromes requiring intraarterial contrast media administration remains to be established.

Purpose

The aim of our study was to assess the influence of gender on the risk of the development of CI-AKI in patients with chronic coronary syndromes, receiving optimal medical treatment and with indications for percutaneous coronary interventions (PCI).

Methods

1023 patients with chronic coronary syndromes and indications to PCI were included in the prospective cohort clinical study. The CI-AKI was defined as a rise in serum creatinine equal to or more than 25% from baseline. Preventive measures included the administration of 0,9% saline with intravenous infusion speed of 1 ml/kg/h (0,5 ml/kg/h for patients with heart failure) before and after the procedure. The contrast media used were either iodixanol or iopromide, which are both known to cause less adverse events than high-osmolar contrast media.

Results

The CI-AKI developed in 132 patients (12,9%). The number of male patients was higher than the female ones (741 and 282, 72,4% and 27,6% respectively). The 95% confidence interval of the means was −0,004 to 0,0088. The F test was performed to compare variances: F was 1,297, DFn 281, Dfd 740, the p value was statistically significant. The CI-AKI developed in 45 females (16% of all the female patients) and 87 males (11,7% of all the male patients). Female patients were more likely to be enrolled in the study in older age (presented in population pyramid). This fact is likely to be due to the menopause and natural history of chronic coronary syndromes in female gender.

Conclusion

The female gender is a significant risk factor of the CI-AKI development in patients with chronic coronary syndromes undergoing percutaneous interventions. Women need to be screened and monitored more closely before any contrast media administration in catheterisation laboratory.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Sechenov University

Influenza vaccination and prognosis for patients with high cardiovascular risk

Cardiovascular and respiratory diseases have been one of the leading causes of mortality in the world for over 15 years. According to the results of various studies, a clear connection was revealed between the incidence of influenza and the decompensation of cardiovascular diseases, which leads to the development of acute coronary syndrome, acute heart failure and myocardial infarction. Also, the incidence of influenza is associated with an increase in the length of hospitalization, treatment costs and patient mortality. Influenza vaccination, especially in patients with high cardiovascular risk, is one of the most important secondary prevention measures. The article is dedicated to an overview of the problems of vaccination against influenza, the study of the prognosis of patients with high cardiovascular risk, as well as general points in the pathogenesis of influenza and cardiovascular diseases.

Russian Medical Society for Arterial Hypertension expert consensus. Resistant hypertension: detection and management

The diagnosis of resistant arterial hypertension allows us to single out a separate group of patients in whom it is necessary to use special diagnostic methods and approaches to treatment. Elimination of reversible factors leading to the development of resistant arterial hypertension, such as non-adherence to therapy, inappropriate therapy, secondary forms of arterial hypertension, leads to an improvement in the patient's prognosis. Most patients with resistant hypertension should be evaluated to rule out primary aldosteronism, renal artery stenosis, chronic kidney disease, and obstructive sleep apnea. The algorithm for examining patients, recommendations for lifestyle changes and a step-by-step therapy plan can improve blood pressure control. It is optative to use the most simplified treatment regimen and long-acting combined drugs. For a separate category of patients, it is advisable to perform radiofrequency denervation of the renal arteries.

[Bidirectionality of cardiovascular risk factors in patients with urolithiasis: current state of the problem]

The most common risk factors for cardiovascular disease and urolithiasis are presented in the article. Data on the prevalence of urolithiasis are discussed, as well as the pathogenetic mechanisms of stone formation in patients with metabolic syndrome, dyslipidemia, and arterial hypertension. The bi-directional relationship of cardiovascular risk factors and urolithiasis is generalized. The role of calcium, uric acid, citrate, changes in urine pH and an increase in body weight in the formation of kidney stones is shown.

Subacute and chronic post-covid myoendocarditis: clinical presentation, role of coronavirus persistence and autoimmune mechanisms

Aim    To study clinical features of myoendocarditis and its possible mechanisms, including persistence of SARS-Cov-2 in the myocardium, in the long-term period following COVID-19.Material and methods    This cohort, prospective study included 15 patients aged 47.8±13.4 years (8 men) with post-COVID myocarditis. The COVID-19 diagnosis was confirmed for all patients. Median time to seeking medical care after COVID-19 was 4 [3; 7] months. The diagnosis of myocarditis was confirmed by magnetic resonance imaging (MRI) of the heart (n=10) and by endomyocardial biopsy of the right ventricle (n=6). The virus was detected in the myocardium with PCR; immunohistochemical (IHC) study with antibody to SARS-Cov-2 was performed; anticardiac antibody level was measured; and echocardiography and Holter monitoring were performed. Hemodynamically significant coronary atherosclerosis was excluded for all patients older than 40 years.Results    All patients showed a clear connection between the emergence or exacerbation of cardiac symptoms and COVID-19. 11 patients did not have any signs of heart disease before COVID-19; 4 patients had previously had moderate arrhythmia or heart failure (HF) without myocarditis. Symptoms of myocarditis emerged at 1-5 months following COVID-19. MRI revealed typical late gadolinium accumulation, signs of hyperemia, and one case of edema. The level of anticardiac antibodies was increased 3-4 times in 73 % больных. Two major clinical variants of post-COVID myocarditis were observed. 1. Arrhythmic (n=6), with newly developed extrasystole or atrial fibrillation without systolic dysfunction. 2. Decompensated variant with systolic dysfunction and biventricular HF (n=9). Mean left ventricular ejection fraction was 34.1±7.8 %, and left ventricular end-diastolic dimension was 5.8±0.7 cm. In one case, myocarditis was associated with signs of IgG4‑negative aortitis. SARS-Cov-2 RNA was found in 5 of 6 biopsy samples of the myocardium. The longest duration of SARS-Cov-2 persistence in the myocardium was 9 months following COVID-19. By using antibody to the Spike antigen and nucleocapsid, SARS-Cov-2 was detected in cardiomyocytes, endothelium, and macrophages. Five patients were diagnosed with lymphocytic myocarditis; one with giant-cell myocarditis; three patients had signs of endocarditis (infectious, lymphocytic with mural thrombosis).Conclusion    Subacute/chronic post-COVID myocarditis with isolated arrhythmias or systolic dysfunction is characterized by long-term (up to 9 months) persistence of SARS-Cov-2 in the myocardium in combination with a high immune activity. Endocarditis can manifest either as infectious or as nonbacterial thromboendocarditis. A possibility of using corticosteroids and anticoagulants in the treatment of post-COVID myoendocarditis should be studied.

The periprocedural myocardial infarction and probability of the developing of the contrast-induced acute kidneys injury in clinical practice. Case report

Nowadays, taking into account the number of elderly patients with sеveral associated diseases requiring percutaneous transluminal balloon coronary angioplasty (PTCA), the risk of the development of unwanted complications is also growing. In this article we present the clinical case, where the PTCA had complications with myocardial infarction of the 4a type without contrast-induced acute kidney injury (contrast-induced nephropathy).

Liver and COVID-19: possible mechanisms of damage

The global epidemic of a new coronavirus infection caused by SARS-CoV-2 is a major threat to human health. In the clinical picture, along with acute respiratory distress syndrome, liver lesions are also noted. The following mechanisms are currently being considered: direct damaging effects of SARS-CoV-2, immuno-mediated inflammation, hypoxia, drug exposure, and reactivation of pre-existing liver disease. We studied 150 patients with COVID-pneumonia who are under inpatient treatment at the University Clinical Hospital No. 1 of Sechenov First Moscow State Medical University. Of these, the presence of SARS-CoV-2 RNA was confirmed by polymerase chain reaction in 84 (56.0%) patients. In 55 (36.7%) patients, an increase in serum aminotransferases was registered, mainly alanine aminotransferase max. up to 572 U/L and aspartate aminotransferase up to a max. of 232 U/L. The long-term consequences are unknown and require monitoring of these patients.

Serum Zinc, Copper, and Other Biometals Are Associated with COVID-19 Severity Markers

The objective of the present study was to evaluate of serum metal levels in COVID-19 patients with different disease severity, and to investigate the independent association between serum metal profile and markers of lung damage. The cohort of COVID-19 patients consisted of groups of subjects with mild, moderate, and severe illness, 50 examinees each. Forty-four healthy subjects of the respective age were involved in the current study as the control group. Serum metal levels were evaluated using inductively-coupled plasma mass-spectrometry. Examination of COVID-19 patients demonstrated that heart rate, respiratory rate, body temperature, C-reactive protein levels, as well as lung damage increased significantly with COVID-19 severity, whereas SpO₂ decreased gradually. Increasing COVID-19 severity was also associated with a significant gradual decrease in serum Ca, Fe, Se, Zn levels as compared to controls, whereas serum Cu and especially Cu/Zn ratio were elevated. No significant group differences in serum Mg and Mn levels were observed. Serum Ca, Fe, Se, Zn correlated positively with SpO₂, being inversely associated with fever, lung damage, and C-reactive protein concentrations. Opposite correlations were observed for Cu and Cu/Zn ratio. In regression models, serum Se levels were inversely associated with lung damage independently of other markers of disease severity, anthropometric, biochemical, and hemostatic parameters. Cu/Zn ratio was also considered as a significant predictor of lower SpO₂ in adjusted regression models. Taken together, these findings demonstrated that metal metabolism significantly interferes with COVID-19 pathogenesis, although the causal relations as well as precise mechanisms are yet to be characterized.

Сardiac myxoma: challenge in diagnostics. Case report

Cardiac myxoma is the most common primary benign cardiac tumor (up to 50% of all primary cardiac neoplasms). The implementation of the modern imaging techniques into the clinical practice, particularly, 2D echocardiography, computed tomography and magnetic resonance tomography (MRI) results to the prompt diagnosis of the myxoma. However, the absence of specific clinical features, insufficient awareness of this condition among the physicians along with a rare prevalence, may lead to a misdiagnosis. This case report is notable for the relatively late diagnosis of a giant left atrial myxoma due to a number of circumstances but with successful surgical treatment.

[Visceral leishmaniasis: a challenging diagnosis in internal medicine]

Leishmaniasis is a vector-born parasitic disease characterized by predominant cutaneous or visceral involvement with fever, hepatosplenomegaly and anemia. Leishmaniasis has relatively high prevalence in tropical and subtropical areas. Several sporadic and mostly imported cases are detected in Russian Federation. Nevertheless, some local incidents are noted in southern areas (Crimea, Dagestan). Lack of epidemiological alertness hampers confirmation of diagnosis and may lead to incorrect treatment. The article summarizes current state of knowledge in epidemiology, diagnostic approach and treatment of leishmaniasis. Particular clinical case is discussed.

[Risk factors for the early development of septic shock in patients with severe COVID-19]

AIM

In a retrospective study, we evaluated factors associated with the early development of septic shock in patients with severe COVID-19.

MATERIALS AND METHODS

We collected medical records of the intensive care unit patients submitted by the local COVID-19 hospitals across Russia to the Federal Center for the Critical Care at the Sechenov First Moscow State Medical University (Sechenov University). Septic shock in crticially ill patients requiring mechanical ventilation was defined as a need in vasopressors to maintain blood pressure.

RESULTS

We studied 1078 patients with severe COVID-19 who were admitted to the intensive care units for respiratory support. There were 611 males and 467 females. The mean age was 61.013.7 years. Five hundred twenty five medical records (48.7%) were received from the Moscow hospitals, 159 (14.7%) from the Moscow region, and 394 (36.5%) from the hospitals located in 58 regions of the Russian Federation. In 613 (56.9%) patients, diagnosis of SARS-CoV-2 infection was confirmed by PCR, and in the other cases it was established on the basis of the clinical picture and the results of the chest CT scan. Septic shock developed in 214 (19.9%) of 1078 patients. In the logistic regression model, the risk of septic shock in patients older than 50 years was higher than in patients of a younger age (OR 2.34; 95% CI 1.533.67; p0.0001). In patients with more severe SARS-CoV-2 infection, there was an increase in the prevalence of cardiovascular diseases, including coronary heart disease and atrial fibrillation, type 2 diabetes and malignant tumors. The risk of septic shock in patients with three or more concomitant diseases was higher than in patients without any concomitant chronic diseases (OR 1.76; 95% CI 1.762.70).

CONCLUSION

The risk of septic shock in patients with acute respiratory distress syndrome induced by SARS-CoV-2 is higher in patients older than 50 years with concomitant diseases, although a severe course of the disease is also possible in younger patients without any concomitant disorders.

[Anemia as a risk factor of contrast-associated acute kidney injury]

AIM

The aim of our study was to assess the role of anemia as a risk factor of contrast-associated acute kidney injury (CA-AKI) in patients with stable coronary artery disease.

MATERIALS AND METHODS

1023 patients with chronic coronary artery disease were enrolled in a prospective, open, cohort study (ClinicalTrials.gov ID NCT04014153). 83 patients had anemia. CA-AKI was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dl or more in serum creatinine from baseline value, assessed at 48 hours following the administration of the contrast. The primary endpoint of the study was the development of CA-AKI according to KDIGO criteria.

RESULTS

CA-AKI developed in 12 (14.5%) patients with anemia according to the relative increase of the level of serum creatinine (25% and more from the baseline). With using the absolute increase of the level of serum creatinine the prevalence of CA-AKI was 2 (2.4%) patients. Patients with anemia had higher rate of CA-AKI than the overall population of the study (14.4% versus 12.7%). Although our results were not statistically significant (р=0.61, odds ratio 1.19, 95% confidence interval 0.632.24).

CONCLUSION

The prevalence of CA-AKI was higher in the group of patients with anemia, but didnt meet statistical significance and needs further evaluation in larger studies.

[Contrast-induced acute kidney injury in chronic coronary artery disease patients with diabetes mellitus and obesity]

AIM

To assess the influence of diabetes mellitus and obesity on contrast-induced acute kidney injury risk in patients with chronic coronary artery disease requiring percutaneous coronary intervention.

MATERIALS AND METHODS

1023 patients with chronic coronary artery disease were enrolled in a prospective, open, cohort study (ClinicalTrials.gov ID NCT04014153). Contrast-induced acute kidney injury was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dl or more in serum creatinine from baseline value, assessed at 48 hours following the administration of the contrast. The majority of the patients were overweight male ones with BMI 29.25.5 kg/m2. The primary endpoint of the study was the development of contrast-induced acute kidney injury according to KDIGO criteria.

RESULTS

The prevalence of contrast-induced acute kidney injury was 12.9% (132 patients). 21.2% suffered from diabetes mellitus, 43% were obese and 12.9% had both diabetes mellitus and obesity. Diabetes wasnt a statistically significant independent risk factor of the contrast-induced acute kidney injury, as well as the combination of diabetes and obesity. In the group of obese patients the prevalence of contrast-induced acute kidney injury was higher (13.4%vs12.5%), but didnt meet statistical significance (p=0.7, OR 0.924, 95% CI 0.641.325). According to the multiple logistic regression model, female gender, age, BMI, weight, arterial hypertension, baseline creatinine were the risk factors of the contrast-induced acute kidney injury development (AUC 0.742,p0.0001).

CONCLUSION

Diabetes mellitus was not associated with higher incidence of contrast-induced acute kidney injury. The prevalence of contrast-induced kidney injury was higher in the group of patients with BMI30 kg/m2, but didnt meet statistical significance and needs further evaluation in larger studies.

Primary Undifferentiated Pericardial Sarcoma after Radiоtherapy for Hodgkin Lymphoma

Various types of sarcomas arise as a result of postradiation chronic fibrous pericarditis. A primary undifferentiated spindle cell pericardial sarcoma is a rare type of sarcoma after radiotherapy. The risk of sarcoma increases with time after treatment of cancer. A 55-year-old woman underwent successful radiation and chemotherapy for Hodgkin lymphoma 20 years ago. She was hospitalized with typical manifestations of severe heart failure. Echocardiography, сomputed tomography of the chest and magnetic resonance imaging scan of the heart detected neoplastic formations of the pericardium. A biopsy of the pericardium was performed. Histological, immunohistochemical, and genetic studies showed a primary undifferentiated spindle cell pericardial sarcoma (an extremely rare type of sarcoma).

[Contrast-induced acute kidney injury in patients with stable coronary artery disease: the most important risk factors and prevalence]

AIM

The aim of our study was to assess the prevalence of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) receiving optimal medical treatment with indications to coronary angiography and intraarterial administration of contrast agents.

MATERIALS AND METHODS

1023 patients with stable CAD were included in the open prospective observational cohort study. The CI-AKI was defined as a rise in serum creatinine 25% from baseline. The mean age of the study group was 61.710.1 years; 72.4% were males and 84.4% had arterial hypertension. A multiple logistic regression model of prediction of CI-AKI was created.

RESULTS

CI-AKI developed in 132 (12.9%) of the patients. The multiple logistic regression model included gender, BMI, weight, age, heart failure, diabetes mellitus, arterial hypertension, anemia, hyperuricemia, proteinuria and baseline serum creatinine. Area under the curve for the model was 0.749 (95% confidence interval 0.7030,795;p0.0001). When trying to build a prognostic model, including baseline GFR and contrast volume, the model lost significance and the AUC diminished.

CONCLUSION

The CI-AKI remains quite a common kidney injury developing in patients with stable CAD undergoing percutaneous interventions. Several risk factors need to be assessed very carefully before any intervention requiring intraarterial contrast media administration especially in patients with comorbidities.

[Miocarditis in Patients with COVID-19 Confirmed by Immunohistochemical]

Aim      Despite the regular heart damage in patients with coronavirus pneumonia caused by SARS-Cov-2, a possibility of developing lymphocytic myocarditis as a part of COVID-19 remains unsubstantiated. The aim of this study was to demonstrate a possibility of lymphocytic myocarditis and to study its morphological features in patients with the novel coronavirus infection (COVID-19) with a severe course.Material and methods   Postmortem data were studied for 5 elderly patients (74.8±4.4 years; 3 men and 2 women) with the novel coronavirus infection and bilateral, severe polysegmental pneumonia (stage 3-4 by computed tomography). COVID-19 was diagnosed based on the typical clinical presentation and positive polymerase chain reaction test in nasopharyngeal swabs. All patients were treated in different hospitals repurposed for the treatment of patients with COVID-19. A standard histological study was performed with hematoxylin and eosin, toluidine blue, and van Gieson staining. Serial paraffin slices were studied immunohistochemically with antibodies to CD3, СD68, CD20, perforin, and toll-like receptors (TLR) 4 and 9.Results In none of the cases, myocarditis was suspected clinically, added to the diagnosis or indicated as a possible cause of death. IHD and acute myocardial infarction were mentioned as error diagnoses not confirmed by the postmortem examination. The morphological examination of the heart identified signs of lymphocytic myocarditis consistent with Dallas criteria for this diagnosis. Myocardial infiltrate was characterized in detail, and a combined inflammatory damage of endocardium and pericardium was described. The immunohistochemical study with cell infiltrate typing confirmed the presence of CD3-positive Т lymphocytes and the increased expression of TLR-4. A picture of coronaritis, including that with microvascular thrombosis, was found in all cases.Conclusion      A possibility for development of lymphocytic viral myocarditis in COVID-19 was confirmed morphologically and immunohistochemically. Specific features of myocarditis in COVID-19 include the presence of coronaritis and a possible combination of myocarditis with lymphocytic endo- and pericarditis.

[Cognitive impairment in patients with arterial hypertension depending on the presence of risk factors for chronic kidney disease at the sanatorium stage]

Vascular cognitive disturbances are widespread in patients with arterial hypertension, especially when attached to arterial hypertension of chronic kidney disease. Each of these diseases has a negative impact on brain vessels and may contribute to cognitive deficits.

THE PURPOSE OF THE STUDY

To evaluate the neuropsychological profile and determine the risk of cognitive impairment in patients with arterial hypertension depending on the presence or absence of risk factors for chronic renal disease at the sanatorium stage.

MATERIAL AND METHODS

200 patients with arterial hypertension of 1st-2nd degree, stage II, risk 2-3 were examined. The level of microalbuminuria, creatinine in blood serum was investigated, the rate of glomerular filtration was calculated. Cognitive functions were evaluated using neuropsychological tests of 10 words, 5 figures, counting down, tables Shulte, MMSE, FAB.

RESULTS AND CONCLUSION

Risk factors for chronic kidney disease were first discovered in 48% of patients. It was revealed that in patients with arterial hypertension and risk factors of chronic kidney disease the risk of occurrence and development of cognitive disorders is 1.46 times higher, the degree of reduction in indicators of arbitrary attention, speed of mental performance, auditory memory is more expressed than in patients with arterial hypertension alone. It was shown that in patients with arterial hypertension and risk factors of chronic kidney disease a moderate degree of multifunctional variant of cognitive disturbances with memory decrease and neurodynamic disturbances is observed.

[Hyperuricemia, gout and high cardiovascular risk - how to manage them in clinical practice]

In recent years, the relationship of hyperuricemia and gout with a high risk of cardiovascular disease has been widely discussed. Therefore, it is important to systematically examine patients in order to diagnose comorbidities, among which cardiovascular disease and its complications occupy a leading place and consider mandatory treatment of patients with hyperuricemia and gout with high cardiovascular risk with lowering drugs, which fully reflects the provisions of the latest European recommendations for the management and treatment of patients with gout.

[Metastatic lesion of the right atrium with renal cell carcinoma]

Tumors in the heart are rare and difficult to diagnose pathologies. There are primary and secondary tumors, the letter tumors include metastases of other tumors. In this work is presented clinical case of metastatic lesion of the right atrium with renal cell carcinoma. Modern methods of diagnostics of patients with intracardiac formations are discussed.

[Correlations between parameters of central hemodynamics and cytokine profile in chronic kidney disease in combination with cerebrovascular diseases]

AIM

To study the relationship between central hemodynamics and arterial stiffness indicators with cystatin C, tumor necrosis factor-alpha (TNF-alpha) and interleukin-(IL)-10 in patients with chronic kidney disease (CKD) in combination with cerebrovascular diseases (CEV).

MATERIAL AND METHODS

One hundred and twenty patients, aged from 19 to 81 years, with signs of chronic renal dysfunction, including 73 with CKD (1st group) and 47 with CKD in combination with CEH (group 2), were examined. 'AngioScan' (Russia) was used to study indices of arterial rigidity. Blood plasma concentrations of TNF-alpha, IL-10 and cystatin C were determined by the enzyme immunoassay.

RESULTS

There is a significant increase (p<0.05) in the systolic, diastolic, central levels of arterial pressure, augmentation index, the index of increase at a pulse rate of 75 per min, the age index, the age of the vascular system and cystatin C content in the patients with CKD in combination with CEV compared to the patients with CKD without accompanying CEH. In the group of patients with CKD in combination with CEV, a correlation was found between the level of TNF-alpha and arterial stiffness index on one side (r=0.318; p<0.05) and the augmentation index on the other (r=0.299; p<0.05).

CONCLUSION

The results confirm the fact that there is a significant increase in the level of plasma cystatin C and a decrease in GFR in patients with CKD in combination with CEV. Correlations were found between the level of TNF-alpha, augmentation index and deterioration of parameters of central hemodynamics and arterial stiffness in CKD in combination with CEH.

[Bilateral impact of cardiorenal relationships in the nephrotic syndrome.]

To study and analyze the cardiorenal relationships in nephrotic syndrome, taking into account sex differences. A total of 272 patients with nephrotic syndrome (NS) aged 16 to 65 years were examined. All patients underwent general clinical examination, electro-and echocardiography, assessment of peripheral and biochemical blood counts. NS was determined with daily proteinuria of more than 3.5 g/1.73 m2 per day, hypoalbuminemia (albumin less than 30 g/l) and hyperlipidemia (total cholesterol more than 5.1 mmol/l). The duration of the National Assembly ranged from 3 months or more. Depending on the gender, the total sample (n=272) was divided into two subgroups: the 1st subgroup - patients with female NS (n=88), the 2nd subgroup - males with NS (n=184). The mean systolic, diastolic, pulse and mean arterial pressure (BP) were significantly higher in male NS patients (p<0.05). Supraventricular and ventricular ectopic activity was significantly more common in males. In the subgroup of women with NA, sinus tachycardia was significantly more frequently detected, a slowing down of the impulse conduction along the bundle of His, a violation of the processes of repolarization of the LV (p<0.05). The final systolic and diastolic sizes of the left ventricle (LV), the thickness of the interventricular septum and the posterior wall of the left ventricle, the diameter of the aorta, the longitudinal size of the left atrium and the right ventricle were significantly larger in the group of males with NA. Significantly lower concentrations of hemoglobin, hematocrit, erythrocyte counts were observed in the subgroup of females with NS compared with men (p<0.05). In the cohort of men with HC, there was a significant decrease in the content of total serum protein (44.8±11.0 g/l versus 49.2±11.2 g/l; p=0.003) as compared with females. In the male subgroup of HC, serum creatinine concentration [97 (81;143) mmol/l versus 86 (68;123) mmol/l; p=0.005] and the degree of daily protein excretion [6,490 (4,865;9,661) g versus 5,585 (4,168;7,625) g; p=0.034] with urine were significantly higher compared with the female subgroup (Table 2). At the same time, in the cohort of men with HC, there was a significant decrease in the calculated GFR [62.3 (46.2; 114.9) ml/min versus 87.0 (67.7;127.5) ml/min; p=0.002]. In case of NS in females, factors of deterioration of cardiorenal interrelations are anemia, sinus tachycardia, slowing down of impulse conduction along the bundle of His. Whereas in the NA subgroup of men, negative factors of cardiorenal interrelations are hypoproteinemia, increased systolic, diastolic, pulse and mean blood pressure, creatinine concentration and daily proteinuria, which was accompanied by a decrease in glomerular filtration rate and an increase in the linear dimensions of the heart.

[Prevention of thromboembolic and hemorrhagic events in patients with atrial fibrillation undergoing elective surgery]

OBJECTIVE

To compare incidence of thromboembolic and hemorrhagic complications in patients with atrial fibrillation (AF) undergoing elective surgery on different schemes of perioperative anticoagulant therapy (ACT).

MATERIAL AND METHODS

There were 86 patients (56 (65.1%) men and 30 (34.9%) women, mean age was 69 (64; 78) years) with non-valvular AF who underwent elective interventions. Forty (46.5%) patients underwent abdominal surgery, 34 (39.5%) - cardiovascular procedures, 12 (14.0%) patients underwent surgery for malignant diseases. We have analyzed incidence of thromboembolic and hemorrhagic events and compliance of perioperative ACT modes with current international guidelines.

RESULTS

Thromboembolic and hemorrhagic events developed in 14 (16.3%) patients. Thromboembolic complications were noted in 6 (7.0%) patients, hemorrhagic events - in 8 (9.3%) cases. Maximum complication rate was observed in case of bridge-therapy (n=12, 20.0%). Cancellation of ACT was followed by 2 (9.5%) complications, bridge-therapy - by 4 (6.7%) thromboembolic complications. Hemorrhagic events were 2 times more common in case of this therapy (n=8, 13.3%). It was found that ESC guidelines for perioperative ACT were applied in less than half of patients (41, 47.7% patients with AF undergoing elective surgery). Half of complications (8 out of 16) occurred if unapproved modes of ACT were used (including 7 cases of bridge-therapy was not necessary). The causes of these complications were inadequate assessment of perioperative risk of thromboembolic and hemorrhagic events; unreasonable administration of bridge therapy.

CONCLUSION

An unambiguous clinical effect of bridge therapy has not been confirmed in patients with high risk of thromboembolic complications. Cancer patients have higher risk of complications compared with others. These events occur mainly due to non-compliance with clinical guidelines and insufficient prevention of thromboembolic events.

[Personalized approach for direct oral anticoagulant prescription: from theory to practice]

Data on possibilities of personalized approach for direct oral anticoagulants (DOAC) choice in patients with atrial fibrillation are presented in the article. We also review clinical and fundamental studies and future perspectives on pharmacogenetic and pharmacokinetic tests to predict the efficacy and safety of DOAC.

Morphologically proved ANCA positive Loeffler's pancarditis: medical and surgical treatment

Loeffler's endocarditis remains is a very rare disease, develops due to eosinophilic inflammation predominantly of the endocardium with an outcome in fibrosis and massive thrombus formation and. He is generally characterized by an unfavorable prognosis. Clinical case of a 42-year-old patient with Loeffler endocarditis is presented. The development of the disease was preceded by a polyvalent allergy, mild dry eye syndrome and pansinusitis with a single eosinophilia of blood up to 16%. The reason for the hospitalization was the appearance of biventricular heart failure. During the previous year, the level of blood eosinophils remained normal, a threefold increase in the level of eosinophilic cationic protein was observed once. A 20-fold increase in the pANCA level, a 2.5-fold increase in the level of antibodies to DNA, an antibody to the nuclei of cardiomyocytes 1:160 were detected. The diagnosis was made on the basis of electrocardiography data (low QRS voltage, atrial hypertrophy), echocardiography, multispiral computed tomography and magnetic resonance imaging of the heart (thickening and delayed contrasting of the endocardium, massive thrombosis of the left ventricular apex with obliteration of its cavity, encapsulated fluid in the pericardium with compression of the right ventricle). Systolic dysfunction, severe signs of restriction and arrhythmias were absent. Trombectomy, tricuspid valve plasty, pericardial resection, suturing of an open oval window were performed. Signs of active inflammation with single eosinophils, vasculitis, perimuscular sclerosis, endocardial sclerosis were detected in morphological and immunohistochemical studies of endo-, myo-, pericardium. Viral genome was not found. The therapy with methylprednisolone 24 mg/day, azathioprine 75 mg/day was started. Six months after the operation, the symptoms of heart failure are completely absent, the thrombosis did not recur.

Cornea verticillata in Fabry disease

AIM

To study the frequency of cornea verticillata in patients with Fabry disease and it's relation to the severity of the disease and the types of mutation in the GLA gene.

MATERIALS AND METHODS

We studied 69 adult (over 18 years) patients with a classic form of Fabry disease that was confirmed by enzymatic and molecular genetic studies. There were 39 males and 30 females. The median age was 39 years [30.0; 50.0]. The severity of Fabry disease was assessed using the Mainz Severity Score Index (MSSI) with a maximum value of 76 points. Depending on the MSSI score, patients were classified into mild (&lt;20), moderate (20-40), and severe (&gt;40) clinical categories.

RESULTS

At least one classic symptom of Fabry disease was present in 88.4% of patients. The majority of patients had the missense mutations of the GLA gene. Cornea verticillata was found in 65.2% of patients and occurred with a similar frequency in males (56.4%) and females (76.7%; p=0.07). Cornea verticillata was the single classic symptom of Fabry disease in only 4.9% of cases, while the rest of the patients presented with angiokeratoma, neuropathic pain and/or hypohidrosis. The frequency of classic symptoms of Fabry disease, as well as renal disease (with the exception of terminal chronic renal failure), brain and heart damage was similar in patients with and without cornea verticillata. Median MSSI scores were also similar in patienths with and without cornea verticillata (20.0 and 18.5 points, respectively; p=0.92). Similar results were obtained in males (26.5 and 30.0 points, p=0.97) and females (16.0 and 16.0 points, p=0.45). The frequency of cornea verticillata did not differ in patients with different types of mutations in the GLA gene.

CONCLUSION

Cornea verticillata occured in 65% of adult patients with Fabry disease, was usually accompanied by the other classic symptoms of the disease, and was not associated with the severity of the disease.

Quality of life of chronic kidney disease patients on renal replacement therapy

The study demonstrated the results of the comparative analysis of various types of renal replacement therapy effects on the quality of life patients with terminal stage of chronic kidney disease on the basis of standardized questionnaires. It has been shown that the quality of life is significantly improved after a kidney transplantation. At the same time, it has also been found that the introduction of home dialysis, epoetins, active metabolites of vitamin D, calcimimetics in the clinic care expanded the opportunities for the labor rehabilitation of the dialysis patients and made their quality of life comparable with the same of the kidney transplant recipients.

[Predictive significance of disturbed water-salt homeostasis in decompensated chronic heart failure patients]

AIM

To estimate association between disorders of salt-water homeostasis on admision and the remote one-year prognosis for patients hospitalized with decompensated CHF NYHA FC III-IV.

MATERIALS AND METHODS

This prospective study was based on clinical amnestic data and results of one-year follow-up of 111 consecutive patients admitted for decompensation of CHF to the State Clinical Hospital No. 24 in January 2015‑February 2016.

RESULTS

The relative risk of death within one year for patients hospitalized for decompensated CHF with disorders of water and salt homeostasis increased 1.43 times by the end of one-year follow-up compared to patients with normal blood levels of sodium and potassium on admission (RR=1.43; 95 % CI: 1.10-1.87; p.

Hepatic involvement in sarcoidosis

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Liver is frequently involved in the pathological process. Wide range of clinical manifestations can be seen: from asymptomatic lesion with normal liver function tests to cirrhosis with portal hypertension. Biopsy plays the key role in diagnosis of the hepatic sarcoidosis. It is essential for morphological diagnosis to exclude other causes of granulomatous liver disease, most often - primary biliary cholangitis. Nowadays there are no standard treatment protocols for patients with hepatic sarcoidosis.

Inhibition of HIF-prolyl 4-hydroxylases as a promising approach to the therapy of cardiometabolic diseases

Prolyl-4-hydroxylases of hypoxia-inducible factor (HIF-P4Hs) are enzymes that, under the conditions of normoxia, cause degradation of the HIF-transcriptional protein, which regulates a number of metabolic processes, including erythropoiesis, glucose level and lipid metabolism. In hypoxic conditions, on the contrary, their activity is suppressed and HIF stabilization takes place. This mechanism, i.e. stabilization of HIF by inhibition of HIF-P4Hs was the basis for the development of drugs designed for treatment of renal anemia, which are currently in stages 2 and 3 of clinical trials and are showing encouraging results. Recently, it has also been reported that inhibition of HIF-P4Hs can be effective in treatment of cardiometabolic diseases - coronary heart disease, hypertension, obesity, metabolic syndrome, diabetic cardiomyopathy and atherosclerosis. The review, based on the most recent data, discusses in detail molecular mechanisms of therapeutic effect of HIF-P4Hs inhibition in these pathological conditions and provides evidence that these mechanisms are associated with HIF stabilization and gene expression, improving perfusion and endothelial function, reprogramming metabolism from oxidative phosphorylation to anaerobic glycolysis, reducing inflammation and having beneficial effect on the innate immune system.