The Concept of Harm Reduction from Tobacco: Past, Present, Future

The concept of tobacco harm reduction (THR) is a speculative and controversial topic in the context of the international battle against the use of all types of tobacco. This concept involves providing tobacco users who are unable or unwilling to quit smoking or using other types of tobacco (snuff, chewing), with modified risk tobacco product (MRTP) for continued use. Skepticism about THR is huge and is associated with the negative experience of tobacco companies to produce cigarettes with a low content of tobacco tar/nicotine, which should have had significantly lower health risks than conventional cigarettes. Paradoxically, such an experience served as a springboard to an increase in the number of tobacco products that potentially have the properties of MRTP. Moreover, some members of the anti-smoking coalition, including WHO, consider the transition of tobacco smokers to MRTP as a strategy with great potential. However, the European Group of Experts believes that the MRTP strategy does not work and will lead to another generation of young people getting used to tobacco. In this article, we have critically analyzed the history of the past and present of tobacco products, myths and contradictions around them. We have tried to evaluate the modern concept of S THR as objectively as possible, which has a high potential for a real reduction in the number of deaths associated with smoking.

Epigenetic Mechanisms of Cardioprotection: Focus is on Activation of Sirtuins

Oxidative stress is a common sign of aging and cardiovascular disease (CVD), including atherosclerosis, heart failure, hypertension, diabetes mellitus and other diseases of the vascular system. In this regard, in recent years, researchers have shown increased interest in sirtuins (SIRTs) — stress adapters and epigenetic enzymes involved in cellular mechanisms for controlling age-related pathologies, cancer and CVD. Among sirtuins, of which there are seven in mammals (SIRT1-SIRT7), SIRT1 and SIRT6 possess the most cardioprotective, anti-inflammatory, atheroprotective and anti-aging properties. In this review, we present a comprehensive analysis of the latest developments in the field of cellular and molecular signaling pathways controlled by two post-translational modifiers — SIRT1 and SIRT6, which have proven their worth as tools to reduce inflammation and oxidative stress at the level of the cardiovascular system. A deeper understanding of the epigenetic mechanisms through which SIRT1 and SIRT6 exert their cardioprotective effect will have widespread implications and will accelerate the development of selective and effective pharmacological agents for modulating sirtuins for the prevention and treatment of CVD.

Differential Diagnosis of Pneumonia as a Complication of Nasal Liquorrhea in the Context of the COVID-19 Pandemic

Nasal liquorrhea — the outflow of cerebrospinal fluid from the cerebrospinal fluid spaces of the cranial cavity into the nasal cavity or paranasal sinuses due to the presence of a congenital or acquired defect in the bones of the skull base and meninges of various etiologies. Nasal liquorrhea leads to potentially fatal complications: meningitis, meningoencephalitis, pneumocephalus, brain abscess. Also, with nasal liquorrhea, less dangerous complications may occur: aspiration bronchopneumonia and gastritis. The article presents a case of aspiration pneumonitis in two patients with nasal liquorrhea treated at the N.N. N.N. Burdenko during the COVID-19 pandemic. Both patients noted the profuse nature of the nasal liquorrhea, complained of coughing in a horizontal position. In both cases, no RNA virus (SARS-CoV-2) was detected during the polymerase chain reaction. Antibodies (IgG, IgM) to coronavirus were not detected. Computed tomography of the chest organs in both cases revealed areas of frosted glass darkening. Since no data was obtained for coronavirus infection (negative tests for coronavirus, lack of antibodies), changes in the lungs were interpreted as a consequence of constant aspiration of cerebrospinal fluid. The patients were admitted to a separate ward. Both patients underwent endoscopic endonasal plasty of the skull base defect. The postoperative period in both cases was uneventful. In both cases, the patients underwent computed tomography scan of the chest organs one month later. On the photographs, the signs of pneumontis completely regressed.

A Clinical Case of Aplastic Anemia After COVID-19 Infection

Aplastic anemia is a rare disease of the blood system characterized by suppression of hematopoiesis in all lines of hematopoiesis, replacement of hematopoietic tissue with fatty tissue and absence of other causes or diseases that can suppress hematopoiesis. The incidence is 2-3 cases per 1 million population per year in the regions of Europe and America, rates are 2-3 times higher in East Asia. The disease most often begins between the ages of 10 and 25 years and over 60 years. The etiology remains unknown in 70-80 % of cases. The frequency of acquired cases predominates over congenital cases. The triggering factors can be chemical, physical exposures, medications, and viral infections. This case report describes a case of a patient developing aplastic anemia, as a result of a coronavirus infection.

Falls As a Problem of an Aging Population, a Modern Look at Risk Factors and Assessment Methods. Role of Fear of Falls in Increasing their Risk

The article presents modern views on the problem of falls in the elderly. There is a global trend of changing the demographic situation - the permanent increase in the proportion of elderly and senile people in the general population, the issues of geriatrics as one of the medical specialties are becoming the most relevant. Among the problems that geriatricians and all specialists involved in the treatment of elderly patients have to solve, one of the most serious is the problem of falls. The article provides a medical review of the assessment of the frequency of falls depending on gender, age, diseases and external factors. The main risk factors for falls and their prevention measures are discussed in detail. Special attention is given to the fear of falls as a significant risk factor. The methods of validation the risk factor with the use of unified questionnaires - “The scale of assessment of the fear of fa lls” and “the Falls efficacy scale” are presented. The purpose of this article is to attract the attention of practitioners to the problem of falls and the fear of falls as one of the significant risk factors, methods of its identification and prevention

Association of Computer Tomography Features Of COVID-19 with Outcomes, Clinical and Laboratory Parameters

Aim: to assess the results of chest computer tomography (CT) of patients with novel coronavirus infection in correspondence with their outcomes, clinical and laboratory data. Methods: retrospective analysis of 962 chest CT scans, outcomes, clinical and laboratory data of all 354 COVID-19 patients hospitalized from April to June 2020. Results: Sensitivity and specificity of CT with polimerase chain reaction (PCR) as a reference were: 98.0 % and 5.7 % respectively; for PCR with CT as a reference: 54.6 % and 70.7 % respectively. Patients with positive and negative PCR tests had no significant differences in mean CT score and CO-RADS score. Cumulative survival was better in patients with lower CT score (significant only for maximal, not baseline scores). CT score changed during hospitalization in survived patients clinically insignificant (from 2 (1-2) to 2 (1-2), p=0.001), and increased in dead (from 2 (1,5-3) to 4 (4-4), p <0.001). Lower CT score and better survival was in females, patient younger than 59 years, with NEWS score <3, without atrial fibrillation. Diabetes mellitus and obesity was associated with higher CT score, but not with survival. Chronic obstructive pulmonary disease, coronary heart disease and chronic heart failure was associated with lower survival, but not CT score. Conclusion: chest CT significantly increases diagnostic accuracy and assessment of the prognosis in COVID-19 patients.

From the History of the Infection Study

The article reflects the development of ideas about infection, from the ancient period to the present day. In the V century Hippocrates proposed a miasmatic theory, according to which diseases are caused by harmful fumes. This paradigm remained dominant for 2.5 millennia. Although the existence of microorganisms has been known since 1676, when they were first described by Anthony van Leeuwenhoek, for a long time the detection of microbes in the biosubstrates of a sick person was considered as a secondary phenomenon in relation to the disease. The theoretical basis for such ideas was the concept of spontaneous generation, which has dominated since the time of Aristotle. The change from the miasmatic theory to the infectious paradigm was due to the fundamental discoveries of Louis Pasteur, who proved the biological nature of fermentation and the infectious genesis of silkworm diseases. The listed discoveries put an end to the discussion about spontaneous generation, became the scientific justification for asepsis and antiseptics and aimed at searching for pathogens of infectious human diseases, which led to a surge in discoveries in microbiology. The causative agents of fever (1868), leprosy (1873), anthrax (1876), tuberculosis (1882), cholera (1883), diphtheria (1884), plague (1894), etc. were discovered. As a result, the infectious theory finally conquered the world. An important achievement of the late 19th century was the allocation of a new type of infectious agents — viruses, which make up the most numerous form of life. With the recognition of the infectious theory at the end of the 19th century an active search for antimicrobial agents began. In 1943, the mass production of the first antibiotic, penicillin, was launched, the discovery of which is called one of the most outstanding achievements in the history of mankind. The use of antimicrobial drugs, along with mass vaccination, led to a significant decrease in the share of infectious diseases in the structure of mortality.

Alternative Options for the Nutritional Status of Patients with Chronic Heart Failure: CHF Phenotype with Sarcopenic Obesity

More than 7 % in the general population suffers from chronic heart failure. It is known that 65 % of people with chronic heart failure are over 60 years old, and the average age of patients is 70 years. Patients with CHF are characterized by a change in nutritive status. Often, patients suffer from malinutrition in the outcome of the disease. However, given the prevalence of obesity and this role in the pathogenesis of diseases leading to chronic heart failure, there are patients with increased body weight. Given the sarcopenia characteristic of elderly patients, it is possible to form a phenotype of CHF with sarcopenic obesity. Sarcopenic obesity is characterized by normal or increased fat mass and miopenia. Sarcopenic obesity provokes hypodiagnosis of disorders of nutritive status, and also, taking into account the hormonal activity of the fat mass, contributes to the progression of chronic heart failure. All this leads to a loss of functional activity of patients, a decrease in their quality of life and requires the development of an individual management plan for such a patient.

Atrial Fibrillation and Heart Failure as the Onset of AL-Amyloidosis

Left ventricular hypertrophy, atrial fibrillation and chronic heart failure are often in the practice of a cardiologist. The etiology of these conditions is very important because the correct early treatment. We are presenting a case of a late diagnosis of amyloidosis in a 53-year-old man. Despite the complex therapy, the course of the disease was complicated by the development of bilateral pneumonia, sepsis, disseminated intravascular coagulation and the patient died. Autopsy confirmed the diagnosis of systemic AL-amyloidosis (type Kappa) with massive damage to the heart, kidneys, lungs, liver, spleen, adrenal glands, thyroid gland, pancreas, gastrointestinal tract, subcutaneous fatty tissue and arterial vessels of the bone marrow. Thus, screening for amyloidosis is necessary in idiopathic LV thickening, atrial fibrillation, and heart failure for timely intravital diagnosis and therapy.

Associations of Gene Polymorphisms and Prognosis in Highly Adherent to Treatment Patients After Myocardial Infarction

Aim. To evaluate the influence of genetic factors on the risk of developing a combined endpoint, during a one-year supervision of patients, who had myocardial infarction and highly adherent to drug therapy.Material and methods. The research included 250 patients with high adherence to treatment with myocardial infarction, using the method of polymerase chain reaction we determined the polymorphisms Thr174Met and Met235Thr in the AGT gene, Arg389Gly and Ser49Gly in the ADRB1 gene, Ser447Ter in the LPL gene and Leu28Pro in the APOE gene, Trp212Ter and G681A in the CYP2C19 gene, and then we evaluated their influence on the prognosis.Results. A significant influence on the risk of developing combined endpoint was noticed for the polymorphism of CYP2C19 (G681A) gene. For the GA genotype of the CYP2C19 gene (G6881A), the OR of developing an unsuccessful outcome was 1.97 (95 % CI 1.05 — 3.69) (P = 0.03). For сarrier-state of A allele the OR was 1.46 (95 % CI 1.06 — 3.64) (P = 0.03). Conclusion. The results received indicate the need for individual approach for the choice of drugs from the group of inhibitors P2Y12-receptors for dual antiplatelet therapy, and if clopidogrel is chosen it is necessary to resolve the issue of pharmacogenetic testing for CYP2C19.