Presence Of Comorbid Pathology Research Articles

Analysis of the characteristic features of psychosocial adaptation of patients with coronary heart disease to chronic heart failure

BACKGROUND: Psychosocial risk factors influence the development and progression of chronic heart failure. Early identification and correction of psychosocial risk factors can reduce their negative impact on the severity of heart failure. AIM: To determine a set of clinical characteristics, socio-demographic indicators, personal and psychological characteristics of patients with coronary heart disease depending on the level of psychosocial adaptation to chronic heart failure. MATERIAL AND METHODS: The study involved 120 patients with coronary heart disease and chronic heart failure. The “Questionnaire for assessing psychosocial adaptation of patients with coronary heart disease to chronic heart failure” developed by the authors was used. Based on the testing results, patients were divided into three groups: adapted, conditionally adapted and maladapted. The first group included 40 patients, the second — 65, and the third — 15. The severity of the clinical course of heart failure, adherence to therapy and the presence of comorbid pathology were assessed. The characteristics of personal response, the severity of neurotic states, a tendency toward type D personality, quality of life, level of social support, and cognitive functions were studied. The socio-demographic characteristics of the patients (age, gender, level of education, position held, level of earnings, nature of alcohol consumption) were analyzed. Statistical and correlation data analysis was performed using the statistical computing environment R 4.2.1. The critical level of significance was considered to be p=0.05. RESULTS: The severity of heart failure decreased (τ=0.38, 95% confidence interval 0.25–0.50, p 0.0001); indicators of left ventricular ejection fraction (ρ=–0.46, 95% confidence interval from –0.59 to –0.30, p 0.0001) and quality of life (ρ=0.63, 95% confidence interval 0.51–0.73, p 0.0001) increased as the level of psychosocial adaptation increased. Adapted and maladapted patients differed in age (p=0.0411), level of education (p=0.0179), position (p=0.0217), personal (p 0.0001) and family (p=0.015) financial well-being, characteristics of personal response, severity of neurotic disorders, as well as the level of social support (p 0.05), adherence to treatment (p=0.0004). Type D personality was registered in 100% of maladapted patients. Adapted patients had higher values of cognitive functions (26.5±4.2 points) and lower comorbidity index scores (5.8±2.7 points) than maladapted patients (23.6±2.3 points, p=0.003; 8.7±3.6 points, p=0.0033). CONCLUSION: Differences in the severity of the clinical course of the disease, socio-demographic characteristics, personal and psychological characteristics of patients with coronary heart disease were found as the level of psychosocial adaptation to heart failure decreased.

Comorbidity and extra pulmonary manifestations in hospitalized patients with coronavirus disease (COVID-19) depending on age and sex

Nowadays, knowledge about the causal relationships between concomitant chronic diseases and the course of coronavirus infection (COVID-19) can make a huge contribution to saving the lives of patients. Determining the impact of concomitant pathology on the severity of the course of COVID-19 will contribute to the identification and assessment of the risk of deterioration of the condition, as well as the implementation of preventive measures in high-risk individuals (vaccination). The aim of the work was to assess the influence of age and sex on the presence of comorbid pathology and the course of the disease in patients who were hospitalized with community-acquired viral pneumonia associated with COVID-19. We carried out a retrospective analysis of the case histories of 260 patients with community-acquired pneumonia associated with coronavirus disease, who were treated in the therapeutic departments of the Covid Center of ME “Dnipropetrovsk regional clinical hospital named after Mechnikov” DRC in 2020-2021. (September-December 2020, January- December 2021), single-center study. All patients included in the analysis underwent general clinical and laboratory methods of research regulated by national recommendations for the management of patients with COVID-19, PCR tests (polymerase chain reaction) for verification of coronavirus disease, CT(computed tomography)/radiography of the lungs. Comorbidity was assessed as the development of the disease before the onset / verification of coronavirus disease according to a patient survey recorded in medical records. One or more comorbid conditions were recorded in 195 (75%) patients. Multimorbidity was recorded in 111 (56.9%) patients from the total number of patients with COVID-19 and comorbid pathology. Analyzing the influence of gender in patients with comorbid pathology, men were significantly more likely to have coronary artery disease (CAD) (p=0.04) and chronic obstructive pulmonary disease (COPD) (p=0.04). A significant difference in age among hospitalized patients with a diagnosis of COVID-19 was revealed, depending on sex (p<0.001). So at the age of up to 65 years, male patients predominated (60.4%), over the age of 65 years – women (68.9%). There was no significant difference in the frequency of occurrence of moderate severity and severe course of the disease of COVID-19, depending on age and sex. At the age of over 65, the presence of type 2 diabetes (p<0.001), hypertension (R<0.001), coronary artery disease (p<0.001) and COPD (p<0.001) was significantly more common.

NATRIURETIC PEPTIDE: DIAGNOSTIC, PROGNOSTIC, AND CLINICAL RELEVANCE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS, ARTERIAL HYPERTENSION AND OBESITY

Natriuretic peptides are one of the main biomarkers of chronic heart failure (CHF). The level of NT-proBNP makes it possible to evaluate the negative prognosis in patients with CHF, as well as to monitor the sensitivity of patients with left ventricular dysfunction to the appointment of treatment. The purpose of the study: to study the NT-proBNP biomarker in comorbid patients with hypertension, obesity, type 2 diabetes and determine the relationship with a number of hormonal and biochemical indicators. Materials and methods: all patients were divided into 4 groups depending on the presence of comorbid pathology in them: patients with hypertension – 1 group – 22 people; patients with hypertension combined with obesity – group 2 – 30 people; Hypertension in combination with type 2 diabetes – group 3 – 31 people; patients with hypertension, type 2 diabetes and obesity – group 4 – 28 people. Determination of the content of N-terminal brain natriuretic peptide (NT-proBNP) in the blood serum of patients was carried out by the immunoenzymatic method on the analyzer "Labline-90" (Austria) using a commercial test system manufactured by the company "Elabscience" (ELISA, China) according to the instructions, which was part of the set. Conclusions. It was established that in patients with hypertension, hypertension in combination with obesity, hypertension in combination with type 2 diabetes, as well as hypertension in combination with type 2 diabetes and obesity, there is a significant increase in NT-proBNP compared to the indicator of the control group (p<0.05). It has been proven that NT-proBNP has a direct correlation with creatinine (p=0.045), urea (p=0.038), triglyceride level (p=0.027) and cholesterol (p=0.031); direct correlation with the level of HbA1c (r=0.202; p=0.0038). The level of NT-proBNP has a significant predictive value for the risk of developing cardiovascular complications in patients with hypertension.

Risk factors for severe COVID-19 in patients with rheumatic diseases

The aim – to study risk factors for severe COVID-19 in patients with rheumatic diseases (RD).Patients and methods. The study included medical histories of 464 patients with RD who were admitted at the V.A. Nasonova Research Institute of Rheumatology from September 27, 2021 to April 26, 2023Results. Age over 60 years, hypertension, obesity, lung disease, chronic kidney disease, coronary heart disease, diabetes mellitus, acute cerebrovascular accident or a history of pulmonary tuberculosis increase the risk of hospitalization in patients with RD with COVID-19 by 3–5 times. In addition, with an increase in the number of concomitant diseases, an increase in the risk of hospitalization was noted by 2–6 times. Taking glucocorticoids, including at a dose of ≥10 mg per day for prednisolone, mycophenolate mofetil and rituximab, leads to an increase risk of hospitalization by 1.5–4.5 times, while patients taking hydroxychloroquine or tumor necrosis factor α inhibitors was more often required outpatient treatment.Conclusions. It has been established that older age, the presence of comorbid pathology and the use of glucocorticoids, including at a dose of ≥10 mg per day for prednisolone, mycophenolate mofetil and rituximab, are risk factors for severe COVID-19.

What should a general practitioner know about the management of patients with venous thromboembolism?

The era of the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) virus has shown that non-core specialists can be involved in the treatment of epidemic diseases. However, the entire burden for the prevention and treatment of venous thromboembolism (VTE) falls on doctors – cardiovascular surgeons, phlebologists. It should be borne in mind that most of the thromboses – more than 2 million cases per year – are asymptomatic, and only a small part has pulmonary embolism, pulmonary hypertension, and death. The survival rate of patients with deep vein thrombosis (DVT) for 8 years is 65 %, with a combination of DVT with pulmonary embolism; the survival rate does not exceed 34 %, so a doctor of any specialty should know how to suspect VTE. The clinical picture of DVT is not always pronounced. Most often, with DVT, patients complain of swelling and pain in the affected lower limb, a decrease in the volume of active movements, and skin cyanosis. Diagnosis of DVT and thromboembolic complications at the non-specialized level should initially consist of assessing the risk of VTE using special scales, among which the Wales scale is of the greatest importance. The gold standard for diagnosing DVT is duplex ultrasound. Among the main indicators for hospitalization is not the fact of the established diagnosis of DVT, but the presence of comorbid pathology, chronic lung diseases, and old age. Additional risk factors include extended DVT, suspected pulmonary embolism, and pregnancy. The goal of anticoagulant therapy is to stop the process of pathological hypercoagulability, the progression of thrombus formation and create conditions for restoring vascular patency, while the pathological idea is that anticoagulants “dissolve the thrombus”. In this regard, anticoagulant therapy is the mainstay of treatment for DVT. To determine the duration of anticoagulant therapy, the etiology of thrombosis is of particular importance – the trigger that led to the formation of thrombotic masses.

Neutrophil gelatinase-associated lipocalin: function, specificity, role in the diagnosis of renal dysfunction in hypertensive patients with concomitant type 2 diabetes and obesity

Background. Neutrophil gelatinase-associated lipocalin (NGAL) belongs to the superfamily of lipocalins whose main function is the binding and transportation of hydrophobic molecules, si­derophores, as the most important ligands of NGAL. The diagnostic significance of NGAL as a marker of renal dysfunction, as well as its prognostic value in terms of the further prognosis of the course of renal pathology has now been confirmed. The purpose of the study: to determine the role of NGAL in the development of renal dysfunction in hypertensive patients with comorbid type 2 diabetes (T2D) and obesity. Materials and methods. One hundred and eleven patients with hypertension (50 men, 61 women) aged 54.37 ± 1.18 years and 20 controls were examined. During the examination, they were divi­ded into 4 groups depending on the presence of comorbid pathology: hypertension — the first group (n = 22); hypertension combined with obesity — the second group (n = 30); hypertension combined with T2D — the third group (n = 31); hypertension, T2D and obesity — the fourth group (n = 28). In all patients, body weight and height were measured, body mass index was calculated, levels of glycated hemoglobin, lipid metabolism, systolic and diastolic blood pressure were measured. The content of NGAL in blood serum was evaluated by the enzyme-linked immunosorbent assay. Results. The level of NGAL in all patients included in the study was significantly higher compared to the control group (p < 0.01). However, it was highest in comorbidity of hypertension, T2D and obesity, which, in turn, indicates a high risk of interstitial fibrosis in these patients. A significant correlation was found between the level of NGAL and the concentration of cardiotrophin (p < 0.032), catestatin (p < 0.001), β2-microglobulin (p < 0.001), cystatin (p < 0.021), atherogenic coefficient (p < 0.011), NT-proBNP (p < 0.014), vitamin D (p < 0.004). The obtained data demonstrate the significant role of NGAL in the development of early cardiovascular and renal complications in our patients. Conclusions. A significant increase in the level of NGAL was found in patients with hypertension, hypertension with T2D, hypertension with obesity, hypertension with T2DM and obesity compared to healthy individuals (p < 0.01). A significant correlation of the NGAL level with the serum concentration of cardiotrophin, catestatin, cystatin C, β2-microglobulin, atherogenic coefficient, NT-proBNP, and vitamin D in the exami­ned patients was proved.

Assessment of clinical and social aspects of the course of coronary heart disease after coronary bypass graphing according to the International Classification of Functioning, Disabilities and Health

BACKGROUND: It has been established that the prognosis of ischemic heart disease patients after myocardial revascularization depends on the presence of comorbid pathology, which includes, in addition to cardiovascular and non-cardiac, low physical activity as well as the patients social status and environmental barriers. The use of the international classification of functioning in this category of patients makes it possible to assess the severity of the impairment of the structures and functions of the organs and systems involved in the process as well as the role of social, personal and contextual environmental factors necessary for the implementation of a comprehensive rehabilitation program.
 AIM: To study structural and functional changes in the cardiovascular system and other organs and systems of the body based on clinical and expert parameters and the International Classification of Functioning, Disabilities and Health, the need for social protection measures, the main directions of complex rehabilitation of patients with coronary heart disease after coronary artery bypass grafting.
 MATERIALS AND METHODS: The study included 221 patients with severe coronary artery disease requiring myocardial revascularization. All the patients have been examined after coronary bypass surgery in the Bureau of Medical and Social Expertise in Saint Petersburg and recognized as disabled by the third group. The amount of surgical intervention in the patients was different; in most cases (55%) 3 coronary bypass grafts have been inserted. Comorbidity has been assessed according to the Charltson and Kaplan Feinstein indices.
 RESULTS: High frequency of comorbid pathology has been revealed; the most common are cardiovascular diseases, less common lung diseases, the diseases of the musculoskeletal system, diabetes mellitus. The value of the Kaplan Feinstein index was 10.08 0.25; Charlson index 6.50 0.16. In addition to structural disorders of the cardiovascular system, moderate dysfunctions of the respiratory and digestive systems, and metabolism have been determined. Violations of the functions and structures of the body led to restrictions on the categories of life activity: the ability to self-service in 85.07%, independent movement in 81.90%, labor activity in 100%. Among the domains of the international classification of functioning that characterize activity and participation, problems with paid labor activity (100%), movement, housework, and recreation have been identified.
 CONCLUSIONS: The study expands the understanding of the frequency of comorbid pathology of disabled people due to coronary artery disease, its impact on prognosis and the development and implementation of an individual rehabilitation program. The international classification of functioning allows to assess the severity of functional and structural changes, disability as well as to determine the need for social protection measures in patients with coronary artery disease.

Cardiotrophin-1 as a prognostic biomarker of cardiovascular complications in comorbid patients with hypertension and concomitant type 2 diabetes mellitus and obesity

Background. Since cardiovascular diseases (CVD) still occupy a leading place in the structure of mortality, the study of biomarkers that can be key in the diagnosis of early signs of the development of cardiovascular pathology continues. One such promising molecule is cardiotrophin-1 (CTF-1). The purpose of this study is to determinate of the circulating level of CTF-1 in comorbid patients with hypertension, and comparative analysis of its serum concentration in the presence of various comorbidities. Materials and methods. 111 patients with hypertension (men/women - 50/61) aged 54.37±1.18 and 20 persons of the control group were examined. In the process of careful examination and supervision of patients, they were divided into 4 groups depending on the presence of comorbid pathology in them: patients with AH- group 1 - 22 people; patients with AH + OB - group 2 - 30 people; AH+T2DM – group 3 – 31 people; patients with AH+T2DM + OB - group 4 - 28 people. Results. A direct correlation of CTF-1 level with weight, BMI, glycated hemoglobin level, SBP and DBP was established (p<0.001). The data we obtained prove that CTF-1 can be a trigger for the occurrence of cardiovascular complications, since its level progressively increases with increasing severity of comorbid pathology, and its highest serum concentration is found in patients with hypertension with concomitant T2DM and obesity. Conclusions. The level of CTF-1 was significantly higher in patients with AH, T2DM, OB compared to patients with AH, patients with AH and OB, as well as with this indicator in the control group. The study of the relationship between the serum level of CTF-1 and metabolic and hormonal indicators in comorbid patients is a promising direction for further research.

Effect of treatment on genetic predictors and quality of life in rheumatoid arthritis patients with type 2 diabetes, hypertension, and obesity

Background. Connective tissue disease, in particular rheumatoid arthritis (RA), is characterized by a progressive joint damage and polymorphism of extra-articular lesions that affect the patient’s quality of life. Although the widespread implementation of basic therapy through the use of disease-modifying antirheumatic drugs has a positive effect on social consequences, the experience gained shows the impossibility of achieving a stable remission of the disease or reducing the activity of autoimmune inflammation against the background of using these medicines in all patients for a number of reasons. One of these reasons is the presence of comorbid pathology, which requires a personalized approach to each person. The objective was to study the quality of life of patients with RA in combination with type 2 diabetes mellitus (T2DM), hypertension and obesity depending on the T-786C polymorphism of the endothelial nitric oxide synthase gene promoter. Materials and methods. A laboratory and instrumental examination involved 110 patients who were treated at the clinical base of the Department of Internal Medicine of Bukovinian State Medical University, Chernivtsi Regional Endocrinology Center, Chernivtsi Regional Clinical Hospital, and Reference Center for Molecular Genetic Research of the Ministry of Health of Ukraine. Results. When assessing the quality of life in the studied groups, a decrease in indicators on all scales was detected. Thus, in RA combined with hypertension and obesity, PF was 1.73 times lower, RP— 1.97 times, BP— 1.44 times, SF— 1.46 times, MH— 1.26 times , RE— 1.66 times, GH— 1.35 times (p<0.05) lower than in patients with isolated RA. Taking into account the T-786C polymorphism of the eNOS gene, it can be asserted that all indicators of quality of life were reduced in the carriers of the СС genotype, in contrast to the carriers of the T-allele: PF— by 2.06 (pTT<0.05) and 2.46 times (pTС<0.05); RP— by 2.0 (pTT<0.05) and 2.87 times (pTС<0.05); BP— by 1.86 (pTT<0.05) and 2.52 times (pTС<0.05); SF— by 1.55 and 2.07 times (рTС<0.05); MH— by 1.42 (pTT<0.05) and 1.53 times (pTС<0.05); RE— by 1.30 (pTT<0.05) and 1.54 times (pTС<0.05); VT— by 3.34 (pTT<0.05) and 3.72 times (pTС<0.05); GH— by 2.32 (pTT<0.05) and 2.38 times (pTС<0.05), respectively. Conclusions. When comparing the quality of life in the studied groups, it can be stated that the lowest indicators on all scales were in patients with RA combined with hypertension, obesity and T2DM and in carriers of the СС genotype of the analyzed gene, which reflected the worst physical condition and psychosocial status.

Cardiotrophin-1 as a prognostic biomarker of hypertension and a key regulator of cardiac glucose metabolism

Background. Hypertension, type 2 diabetes mellitus (T2DM), and obesity are among the most common diseases in the world, and their growth rates are of a pandemic nature. Since cardiovascular diseases still occupy a leading place in the structure of mortality, the study of biomarkers continues that can be key in the diagnosis of early signs of cardiovascular pathology. Such promising molecule is cardiotrophin-1 (CTF-1). CTF-1 is a protein with a molecular weight of 21.5 kDa, which belongs to the interleukin-6 (IL-6) family. The purpose of this study is to evaluate the circulating level of CTF-1 in comorbid patients with hypertension, and to conduct a comparative analysis of its serum concentration in the presence of various comorbidities. Materials and methods. One hundred and eleven patients with hypertension (men/women— 50/61) aged (54.37±1.18) years and 20 persons of the control group were examined. In the process of examination, they were divided into 4 groups depending on the presence of comorbid pathology: hypertension— group 1 (n=22); hypertension combined with obesity— group 2 (n=30); hypertension and T2DM— group 3 (n=31); hypertension, T2DM and obesity— group 4 (n=28). In all patients, body weight and height were measured, body mass index (BMI) was calculated, glycated hemoglobin (HbA1c) levels, lipid metabolism indicators were determined, systolic and diastolic blood pressure levels were measured. CTF-1 content in blood serum was determined by enzyme-linked immunosorbent assay. Results. A direct correlation of CTF-1 level with weight, BMI, HbA1c level, systolic and diastolic blood pressure was found (p < 0.001). The data obtained prove that CTF-1 can be a trigger for the occurrence of cardiovascular complications, since its level progressively increases with increasing severity of comorbid pathology, and its highest serum concentration is found in patients with hypertension, concomitant T2DM and obesity. The detected changes demonstrate the role of CTF-1, the adipose tissue hormone, in the development of comorbid pathology and make it possible to assert that CTF-1 is a potential biomarker of cardiovascular complications. Conclusions. The level of CTF-1 was significantly higher in patients with hypertension, T2DM, obesity compared to those with hypertension, hypertension and obesity, as well as compared to this indicator in the control group. The concentration of CTF-1 in blood serum positively correlates with the levels of systolic and diastolic blood pressure, body weight, BMI, total cholesterol and HbA1c level. The study of the relationship between the serum level of CTF-1 and metabolic and hormonal indicators in comorbid patients is a promising direction for further research.

Some aspects of the safety of Russian vaccines against COVID-19 in employees of medical organizations

Medical staff and teachers are at high risk of infection. In this connection, it seems relevant to study the effectiveness of the safety of preventive measures aimed at reducing the incidence. A separate issue of which is the results of vaccination of risk groups for infection with SARS-CоV2. The purpose of the study is to evaluate the frequency of registration of post-vaccination reactions of various vaccines against COVID-19 approved for use in Russia among medical staff and faculty of medical higher educational institutions (HEI). A cross-sectional, retrospective, cross-sectional online study was conducted between January and March 2022. The survey involved the teaching staff and medical workers of medical higher educational institutions (HEI) and their subordinate clinics (n = 6032). The majority of vaccinated employees of medical institutions and medical schools had a good tolerability of immunization.Serious adverse events were not registered. A higher incidence of PE and NE was observed in respondents after the first vaccination (p < 0.05). Most often, respondents reported an increase in body temperature (6.9–21.7 %), myalgia (5.5–21.2 %), general weakness (8.4–23.6 %), arthralgia (1.7–9.7 %), local reactions (0.8–16.7 %). In more than 85 % of cases, the above complaints were detected in the first 3 days from the moment of vaccination. A history of COVID-19 infection increased the risk of local and systemic adverse reactions. Gender characteristics of the post-vaccination reaction were revealed, manifested by more frequent registration of NE and PE in men under 35. An inverse relationship between the frequency of NE and PE with age was determined. The presence of comorbid pathology in two or more systems, regardless of age, increased the risk (OR) of various PE and NE from 1.047 to 1.539. The results can be used as an additional tool when planning a personalized approach to vaccinating healthcare workers against COVID-19.

Treatment of patients with COVID-19-associated immune thrombocytopenia in real clinical practice

Aim. Demonstration of three clinical cases of immune thrombocytopenic purpura (ITP) that developed during the pandemic of a novel coronavirus infection (COVID-19) from the personal practice of the authors.Materials and methods. A brief review of the literature on the diagnosis and differential diagnosis of COVID-19-associated ITP is presented. Three clinical observations of this pathology are given.Results. In two situations, thrombocytopenia developed after severe COVID-19-associated pneumonia. In one case, ITP was diagnosed after a viral infection; PCR test for COVID19 was negative. A young patient without comorbidities with severe thrombocytopenia and hemorrhagic syndrome was treated with glucocorticoids and thrombopoietin receptor agonists (TPO-RAs). After achieving remission, glucocorticoids were first discontinued, and then TPO-RAs. In elderly patients with a serious comorbid pathology, glucocorticoids were prescribed for a short time, and remission was achieved with TPO-RAs.Conclusion. The choice of therapy for ITP that developed during the COVID-19 pandemic depends on the clinical situation, the presence or absence of COVID-19 infection, the patient’s somatic status, and the presence of comorbid pathology. TPO-RAs play an important role in the treatment of ITP, including those associated with COVID-19.

Vascular age detected by volumetric sphygmography in patients with arterial hypertension

Aim. Assessment of vascular age by volumetric sphygmography and its relationship with the main clinical and laboratory parameters in patients with arterial hypertension. Materials and methods. 46 patients with arterial hypertension were examined, including 26 women (56.5%) and 20 men (43.5%). The mean age was 67.0 [60.0; 73.5] years. Clinical and laboratory parameters were analyzed, including body mass index, lipidogram, fibrinogen, blood creatinine levels, and glomerular filtration rate. Vascular age was assessed using the BPLab-Vasotens apparatus (LLC Petr Telegin, Russia). Results. Vascular age in patients with arterial hypertension was 69.0 [64.0;76.0] years and did not differ statistically from the passport age (p>0.05). Positive relationships were found between vascular age and the level of pulse pressure (r=0.65, p<0.001), index of reflection (augmentation) of pulse wave growth (r=0.29, p=0.04). No relationship was found between the stage of arterial hypertension, the presence of comorbid pathology, body mass index, lipid profile, creatinine, glomerular filtration rate, fibrinogen, and vascular age. In men, vascular age was less than in women – 65.5 [59.0; 70.5] years and 72.5 [67.0; 78.0] years, respectively (p = 0.02). In the group of women, the augmentation index of pulse wave growth and the level of fibrinogen were higher than in the group of men. Conclusions. There were no statistically significant differences in passport and vascular age, determined by volumetric sphygmography, in patients with hypertension at various stages of the disease, depending on the presence of comorbid pathology, lipid status, and renal dysfunction. When analyzing hemodynamic parameters, direct links were established between vascular age and pulse arterial pressure, the index of reflection (augmentation) of the pulse wave increase. In the group of women with a higher indicator of vascular age, an increase in the augmentation index of the increase in pulse wave and fibrinogen was revealed.

Value of Safety of Anticoagulant Therapy in Elderly Patient with Atrial Fibrillation and High Risk of Bleeding

The review article discusses the safety issue of anticoagulant therapy in elderly patients with atrial fibrillation and high risk of bleeding. An evidence base is presented demonstrating the high safety of rivaroxaban in patients over 80 years of age, with a high risk of bleeding and cardiovascular complications, the presence of comorbid pathology, geriatric syndromes and chronic kidney disease (including in combination with anemia). The problem of low adherence to treatment in elderly patients and the possibility of solving it were separately considered.

The role of inflammation in the development of diabetic polyneuropathy and the possibility of its correction

To study the effect of the combined drug Cytoflavin on the mechanisms of nonspecific inflammation in the treatment of diabetic polyneuropathy (DPN) with an assessment of the dynamics of the TNF-α index. An open comparative prospective observation of patients with a history of DPN for more than 5 years and a high level of TNF-α was carried out. All patients underwent basic oral combined hypoglycemic therapy, the main group used the combined drug Cytoflavin 10 ml (per 200 ml 0.9% NaCl) for 10 days, followed by the transition to the enteral form of the drug, 2 tablets 2 times a day for 1 months The main indication for the appointment of Cytoflavin was the presence of comorbid pathology in the form of cerebrovascular disease in all studied patients. The severity of clinical symptoms of DPN, the quality of life (QOL) of patients, as well as the dynamics of the level of TNF-α as an indicator reflecting the process of inflammation were assessed. As a result of the treatment in the study group, there was an improvement in QoL, a decrease in the severity of sensory complaints and a decrease in the level of TNF-α, which may indicate a possible anti-inflammatory mechanism of the combined drug Cytoflavin. Cytoflavin can inhibit inflammation and reduce the severity of sensitive disorders in patients with DPN.

Reasonable Incomplete Myocardial Revascularization in Patients with Chronic Heart Failure and Reduced Left Ventricular Ejection Fraction

The aim. To evaluate the results of incomplete myocardial revascularization with percutaneous coronary intervention (PCI) in patients with ischemic cardiomyopathy and heart failure with reduced left ventricular ejection fraction based on the residual SYNTAX Score (rSS) scale.
 Materials and methods. This prospective observational one-center study was conducted at the Ukrainian Children’s Cardiac Center, Clinic for Adults and included 192 patients whounderwent coronary angiography and myocardial re-vascularization using PCI. Baseline demographic and clinical parameters, including gender, age, presence of comorbid pathology were obtained from the medical history of each patient retrospectively. The results of revascularization were evaluated over a period of 2 years (from March 2020 to March 2022). To assess the completeness of revascularization, the rSS scale was used, and coronary angiography was repeated.
 Results and discussion. The most significant adverse events during 24 months of follow-up, associated with the severity of coronary artery damage according to the SYNTAX scale ≥23 points, were: death from any cause with odds ratio (OR) 6.9 (95% CI, p = 0.05); myocardial infarction (MI) with OR 5.5 (95% CI, p = 0.001); the combined endpoint was OR 2.4 (95% CI, p = 0.005). Over a 2-year follow-up period,results of myocardial revascularization according to the rSS scale were evaluated the effect of coronary artery stenting with minimal residual atherosclerotic narrowing (rSS ≤8) and significant arterial lesions (rSS ≥9) on indicators such as all-cause mortality, myocardial revascularization, re-hospitalization, recurrent acute MI and stroke were analyzed. Data analysis showed statistically significant difference in all indicators in favor of the group with a score of rSS ≤8 (р <0.05).
 Conclusions. The rSS scale in patients with coronary artery disease and heart failure with reduced left ventricular ejection fraction after PCI is a statistically significant criterion for the impact on the combined endpoint. In addition, an rSS score ≥9 was associated with a significantly higher riskof all-cause mortality, recurrent acute MI, and recurrent revascularization. A stratified rSS score ≥9 in ischemic cardiomyopathy with left ventricular ejection fraction ≤40% was more often observed in patients with existing comorbid pathology, such as hypertension, diabetes mellitus, stroke, peripheral artery disease.

Resolution of the consensus of the Russian Federation experts on the diagnosis and treatment of osteoarthritis, 2022

Osteoarthritis (OA) is the most common joint disease due to the increasing life expectancy of the world's population. Every 2nd patient over the age of 50 suffers from knee or hip OA, and this is directly related to the increased burden on healthcare. Accumulated data on the comorbid profile of patients with OA dictate the need to identify disease phenotypes in order to provide personalized care. Individual clinical manifestations of OA also require a differential approach: the pain treatment requires consideration of the patient's psycho-emotional profile and the possibility of involving nociceptive pathways in the process. However, due to the ambiguity of existing clinical guidelines, most experts note a number of difficulties in prescribing treatment for patients with OA.The resolution presents an agreed opinion of experts on the algorithms for managing patients with OA, starting from the primary level, with the gradual involvement of related specialists. Some issues of a personalized approach are considered depending on the presence of comorbid pathology and the severity of individual symptoms of the disease. The prospects of the combined use of pharmacological and non-drug methods of treatment are noted; emphasis was placed on the importance of rehabilitation measures at the first level of medical care, provided to patients with OA, long before the development of structural changes.The proposed algorithms for managing patients can be considered as the basis for future recommendations for managing patients with this pathology.

PATHOLOGICAL IMMUNITY CHANGES IN COMORBID PATIENTS WITH EXACERBATION OF BRONCHIAL ASTHMA

The aim of the study – to investigate immunological changes in patients with exacerbation of bronchial asthma with different severity and controllability depending on the presence of comorbid pathology. Materials and methods of research. The work is based on the analysis of data from a comprehensive clinical and laboratory examination of 190 patients with exacerbation of asthma. The relative content of T–lymphocytes and their main subpopulations was determined on a flow cytofluorimeter FACS Calibur (Canada) by phenotyping lymphocytes with monoclonal antibodies (BECKMAN COULTER, USA) to surface membrane differentiation antigens (CD): CD3+19– (pan T-cells), CD4+–8+– (T−helpers/inducers), CD4–8+ (cytotoxic T lymphocytes), CD3–16+ (natural killers). To identify the imbalance of immunoregulatory subpopulations of T cells, the immunoregulatory index was calculated – the ratio of the number of CD4+8– Lf and CD4-8+ Lf. To calculate the absolute content in the peripheral blood of individual populations of Lf, leukogram indicators determined on the hematological analyzer ABH-miscros60, France were used. The proliferative activity of lymphocytes was evaluated in cultures of whole blood in the reaction of blast transformation of these cells with morphological accounting of the results. Statistical processing of the obtained data was carried out using licensed software products included in the Microsoft Office Professional 2007 package, license Russian Academic OPEN No Level № 43437596 in Excel. Conclusions. In moderate asthma, the frequency of pathological changes in the T-system of immunity did not depend on the presence of comorbid pathology, as a rule. In severe asthma, an increase in the content of pan–T cells occurred 1.2 times more often than in moderate asthma, but this was not observed in people with concomitant pathology. In this group, the frequency of increasing the content of T–helpers and decreasing the content of cytotoxic T – cells in patients with severe asthma without concomitant diseases was 1.3 times more frequent than in patients with comorbid pathology. No pathological changes in the T–system were detected in patients with controlled asthma. In partially controlled asthma, these changes were registered 1.5 times more often than in controlled asthma, and in its uncontrolled course, the prevalence of pathological changes in the T–system of immunity was much higher than in the two previous groups. In patients with concomitant diseases, these changes, as a rule, had a higher frequency than in patients without comorbid pathology.

Early and long-term neurological complications of chemotherapy in oncology (literature review)

An analysis of the clinical manifestations of complications caused by the toxic effect of chemotherapeutic drugs used in the treatment of malignant neoplasms was carried out. The variety of clinical symptoms that develop against the background of chemotherapy for malignant neoplasms leads to difficulties in differential diagnosis of a primary neurological disease and the identification of complications during treatment. The severity of these complications depends on a number of factors, including the drug used, its dosage and duration of use, the use of various methods of combination therapy and radiation methods, as well as the presence of comorbid pathology in patients. A clear understanding of the mechanisms of development of neurotoxicity and timely diagnosis of such conditions is a priority task of modern clinical medicine Modern methods of treating patients with malignant neoplasms should be based on a multidisciplinary medical approach, including a set of measures to prevent unwanted toxic effects of treatment, stratify individual mortality risks and develop methods of rehabilitation and medical examination.

Фактори ризику формування ускладненого перебігу олігоменореї в дівчат-підлітків

The purpose - to identify significant prognostic criteria for the development of a complicated course of oligomenorrhea. Materials and methods. A clinical and hormonal examination of 64 adolescent girls with oligomenorrhea aged 12-18 was carried out. The following were determined: physical with determination of body mass index, sexual development, parameters of the hormonal background, vitamin D status, lipid spectrum and the state of carbohydrate metabolism. Results. The most informative sings regarding the formation of metabolic complications of the course of oligomenorrhea were selected by determining the informative clinical and anamnestic signs, hormonal indicators and the status of vitamin D. The following clinical parameters, which may indicate a complicated course of oligomenorrhea with disturbances in carbohydrate metabolism, had the greatest overall informativeness: macrosomia at birth; the mother’s age is more than 35 years at the time of our patient’s birth; in a girl, the age of menarche is up to 11 years, the presence of comorbid pathology (especially cardiovascular disorders) and body weight deficiency. The greatest prognostic significance from the hormonal parameters had high levels of luteinizing hormone, testosterone, total cholesterol, and low estradiol. The clinical, anamnestic and hormonal indicators that may indicate the formation of complications from lipid spectrum disorders were found. It was: deviation of the body weight at birth in both sides, high serum levels of prolactin, cortisol, normative follicle-stimulating hormone, and a moderate decrease in the level of vitamin D. Conclusions. Significant risk factors for the formation of metabolic complications in girls with oligomenorrhea have been identified. Using them makes it possible to timely determine the prognosis of the course of oligomenorrhea in the majority of patients already at the early stages of the formation of this pathology, to decide on therapy and the implementation of therapeutic and preventive measures in the future. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the SI «Institute of Health Care of Children and Adolescents of the NAMS of Ukraine». The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.