Features of acute decompensation of heart failure in patients with type 2 diabetes mellitus with anemia and latent iron deficiency

Objective: to assess the contribution of anemia and latent iron deficiency (LID) to the formation of acute decompensation of chronic heart failure (ADHF) in patients with diabetes mellitus (DM) type 2 in history.Materials and methods: a one‑time screening clinical non‑randomized study was conducted. 98 patients with ADHF were examined according to the criteria for inclusion and non‑inclusion, among which 47 (48%) patients suffered from type 2 DM. Among patients with impaired carbohydrate metabolism, 14 (29.8%) patients had an anemic syndrome verified.Results: the prevalence of anemia among hospitalized patients with ADHF against the background of type 2 DM was 29.8%, LID without anemia – 51.5%. Anemic syndrome in patients with ADHF and type 2 DM was represented by iron deficiency anemia in 85.7% and anemia of chronic conditions in 14.3% of cases. In 2/3 of the patients, anemia corresponded to moderate severity. The relative risk (RR) of the development of ADHF against the background of type 2 DM and anemia increases by 2.4 times, in the presence of LID – by 2.9 times. The presence of coronary artery disease, myocardial infarction in history, atrial fibrillation with a heart rate of more than 110 beats per minute, renal dysfunction, high activity of nonspecific inflammation were risk factors for the formation of ADHF in patients with type 2 DM and anemia. The presence of left ventricular hypertrophy in patients with anemia increased the RR of the development of ADHF by 1.8 times, the presence of chronic kidney disease – by 1.7 times, with an increase in the excretion of albumin/protein in the urine >30 mg/g – by 5.7 times, with tubular dysfunction – by 2.4 times, with an increase in aortic stiffness – by 3.5 times.Conclusion: the prevalence of anemia and LID among patients with ADHF and type 2 DM is high. These conditions were risk factors for the development of ADHF and its progression. ADHF in patients with type 2 DM against the background of anemia and LID was characterized by a more severe course, a more pronounced lesion of the target organs.

Evaluation of the effectiveness of drug treatment in patients with arterial hypertension and insomnia

Objective: chronic sleep disturbance is a comorbid condition with arterial hypertension, often combined with affective disorders, anxiety, depression. Forced sleep deprivation in patients with hypertension indicates a high activity of the renin‑angiotensin‑aldosterone system (RAAS) and desynchronosis of biological rhythms caused by a probable deficit in melatonin secretion during the night. Timely elimination of any pathological process associated with insomnia and arterial hypertension (AH) in the early stages of its development is a prerequisite for the effectiveness of therapy. Therefore, initial therapy should help neutralize the adverse effects of RAAS and improve the 24‑hour blood pressure (BP) profile. The aim of this study was to determine the therapeutic effect of monotherapy with an angiotensin converting enzyme (ACE) inhibitor, As well as in combination with a synthetic analogue of melatonin, on the course of hypertension and parameters of systemic hemodynamics in patients with first degree hypertension with insomnia at the onset of the disease. Combined therapy with an ACE inhibitor and a synthetic analogue of MT in patients with hypertension and insomnia was accompanied by an improvement in the clinical state, achievement of the target blood pressure level in most patients, positive dynamics of central blood pressure parameters and indicators reflecting the rigidity of peripheral arteries.

The experience of successful use of melatonin, L‑arginine and L‑carnitine in treatment post-COVID‑19 pain syndromes in persons with cystic transformation of the pineal gland

As an introduction, the article presents a small review of the literature devoted to the problem of clinical variants of postovoid syndrome and, in particular, headaches and back pain. There are 6 cases with various headaches and 1 case with back pain in patients with cystic transformation of the pineal gland after a verified COVID-19 infection. All patients were diagnosed with melatonin, L‑arginine and L‑carnitine deficiency before treatment. After the replacement therapy, the pain syndrome was stopped in all patients within 10 days, and a month after the start of treatment, the indicators of melatonin, L‑arginine and l‑carnitine returned to the reference values of the norm.

Study of type 1 vascular adhesion molecules in patients with acute myocardial infarction with ST segment elevation at different body weights

Objective: to study the level of adhesion molecules in patients with STEMI with different BMI at the hospital stage and 12 months after the index event.Materials and methods: the study included 126 people with STEMI who had undergone PCI and 27 people in the control group. The analysis of the level of svcam‑1 in peripheral blood at the beginning of the disease and after 12 months was carried out, BMI and waist volume were measured. An assessment of the nature and frequency of complications after STEMI was performed.Results: the levels of biomarkers of the vascular endothelial adhesion molecule type 1 increase during the acute period of stemi, statistically signifi tly decrease, but remain increased by 3.5 times 12 months after the index event compared with the initial values. There was no association of VCAM‑1 with visceral obesity in the groups of our patients. Vascular endothelial adhesion molecules of type 1 increase in patients with a fatal outcome, as well as with an increase in the severity of OSN and CHF. Thus, VCAM 1 can be a predictor of an unfavorable outcome of AMI.Conclusions: the article presents the study of a marker of systemic inflammation VCAM‑11 in patients with STEMI with various types of obesity or BMI at the stage of hospitalization and outpatient follow‑up during the year. The determination of the VCAM‑1 level can be used to assess the intensity of the inflammatory process and the risk of adverse outcomes.

Clinical observation of interstitial lung injury caused by the use of humidifier

Humidifier lung syndrome is a rare phenotype of hypersensitive pneumonitis (HP) caused by inhalation of fumes from contaminated climate appliances such as a humidifier and air conditioner. Since the described syndrome is rarely found in the Russian Federation, the practitioner should be wary of this pathology, carefully collect an anamnesis from the patient, and also carry out differential diagnostics with lung lesions of autoimmune, drug, infectious genesis. HP therapy includes exclusion of contact with the etiological factor and the appointment of systemic hormonal therapy.

Rare anomaly of kidney development – L-shaped fusion

Within the framework of the publication, an L‑shaped fusion of the kidneys (horseshoe‑shaped) is considered, referring to the category of asymmetric fusion. The presented clinical case is an extremely rare form of congenital anomaly of renal fusion, demonstrating the difficulty of verifying the correct diagnosis. The article presents the results of a tomographic study, which, in addition to enlargement of the kidneys, recorded signs of dysplasia of the left ureter (stricture) and signs of an arterial vascular bed (aberrant artery of the upper part of the L‑shaped horseshoe).

The role of diacereins in the treatment of osteoarthritis from the point of view of a new paradigm of pathogenesis

Among the most common diseases of humanity in patients of the older age group, there is an articular pathology with degenerative changes in the hyaline cartilage, which significantly limits the functional activity of the locomotor apparatus. The rapid development of experimental scientific research in recent decades has made it possible to revise the concept of the pathogenesis of this process with confirmation of the leading role of inflammation in the development of functional and structural damage in this disease. These new data supported the change in the name of the disease from “osteoarthros” to “osteoarthritis” and justified the positive effects of individual drugs. The proposed lecture material discloses the topic of the modern understanding of the pathogenesis of osteoarthritis and the additional benefits of using drugs from the diacerein group due to their anti‑inflammatory and chondroprotective effect.

Non-motor manifestations in patients with Parkinson's disease

Objective: to study the structure of NMS, their frequency and clinical significance at all stages of PD; to conduct a comparative analysis of the structure of NMS in PD, depending on the stage, form of the disease and gender characteristics of patients.Material and methods: examined 100 patients with PD, 31 patients as the control, and 11 patients as the comparison with Parkinson’s syndrome. The severity of movement disorders was assessed using the Hen and Yar scale. All patients with PD were also clinically assessed according to the UPDRS scale (parts II, III). Cognitive functions were assessed according to the Montreal CI scale (MOCA). The patients’ neuropsychological status was assessed using the Hospital Anxiety and Depression Scale (HADS).Results: vegetative disorders are a frequent manifestation of PD; they differ significantly depending on the gender of the patient and on the stage of the disease. In 20% of patients with PD clinically pronounced depression and severe cognitive impairment were revealed. Conclusion: non‑motor disorders are distinguished by a wide variety of manifestations and combinations, and their structure changes significantly from early to late stages of PD. The presence of NMS is an obligatory sign of PD. Although the structure of non‑motor manifestations of the disease is not specific, attention is drawn to the combination of more than ten different NMS in most patients, which does not occur with natural aging.

Features of gene polymorphism in comorbid patients with arterial hypertension and coronary heart disease

Objective: to assess the prospects of using genetic testing for early detection of patients with arterial hypertension (AH) with a high risk of developing coronary heart disease (IHD).Material and methods: we examined 100 patients with hypertension, who were divided into 2 groups: patients with hypertension without ischemic heart disease (62%, 62 people) and patients with hypertension with ischemic heart disease (38%, 38 people). All patients underwent a standard volume of diagnostic procedures, as well as molecular genetic research. Results: the specificity of the carriage of gene polymorphism was revealed, depending on the presence of isolated AH or AH in combination with IHD in patients. Patients with AH and IHD are characterized by the presence of the CC genotype and the C allele of the ΝΟS3 gene (p = 0,040 and p = 0,035), while the TT genotype of the T‑786C polymorphic marker of the NOS3 gene is characteristic of patients with isolated AH. Conclusion: the study of the genetic aspects of comorbidity is theoretically important for understanding the mechanisms of its formation. From a practical point of view, the opportunity to use modern genetic approaches for early screening of hypertensive patients with a high risk of developing cardiac comorbid pathology is valuable.

The pathogenetic significance of endothelial dysfunction in the development of diabetic nephropathy in patients with type 2 diabetes mellitus

Objective: to determine the level of circulating markers of endothelial dysfunction (endothelin‑1, von Willebrand factor (vfV), endothelial NO-synthase (e‑NOS)) in the blood serum of patients with type 2 diabetes mellitus (DM), as well as to assess the pathogenetic significance endothelial dysfunction in the development of diabetic nephropathy.Materials and methods: the study included 93 patients with type 2 DM, including 28 men (30.1%) and 65 women (69.9%), aged 30 to 79 years, the average age of patients was 59.7±8.4 of the year. The main group included patients with both newly diagnosed type 2 DM and a long-term diabetic history. The duration of the disease averaged 9.5±7.5 years. The majority of patients with DM type 2 (92.5%) at the time of inclusion in the study had various variants of microvascular complications of diabetes, only a small number of patientsin this group (7.5%) had no signs of diabetic angiopathy. Signs of various stages of diabetic nephropathy were observed in 60 patients (69.2%). The comparison group consisted of 30 patients with essential arterial hypertension, including 12 men (40%) and 18 women (60%), aged 34 to 70 years, on average 56.1 ± 8.1 years. The control group consisted of 32 apparently healthy individuals. In all patients, along with routine methods of clinical, laboratory and instrumental examination, the level of circulating markers of endothelial dysfunction (endothelin‑1, von Willebrand factor (vWF), endothelial NO-synthase (e‑NOS)) in blood serum was measured using enzyme-linked immunosorbent assay (ELISA).Results: in patients with DM type 2 and diabetic nephropathy, a statistically significant increase in the concentration of circulating markers of endothelial dysfunction was revealed in comparison with hypertensive patients and healthy individuals. An increase in the level of endothelin‑1 relative to the borderline reference value was found in 73 (78.5±4.1%), vfV in 63 (67.7±4.8%) and e‑NOS in 65 (69.9±4.7%) of patients with DM type 2. In the groups of participants with hypertension and healthy individuals, endothelial imbalance was noted by us significantly less often than in patients with DM type 2, the levels of endothelin‑1 and vfV in people with hypertension were increased in more cases than in healthy individuals. It was noted that the levels of circulating markers of endothelial dysfunction increase with an increase in the duration of DM type 2, and also significantly increase under conditions of carbohydrate decompensation.Conclusion: the results obtained confirm the pathogenetic role of endothelial dysfunction in the development of diabetic nephropathy in patients with type 2 diabetes, increasing endothelial imbalance in persons with a long diabetic history and lack of compensation for carbohydrate metabolism.