Medical Journal of the Russian Federation
ISSN (print): 0869-2106, ISSN (online): 2412-9100 Founder: Izdatelstvo Meditsina Editor-in-Chief: Boris K. Romanov, MD, Dr. Sci. (Medicine) Frequency / Access: 6 issues per year / Hybrid Included in: White List (4rd level), Higher Attestation Commission List, RISC
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READ the details online (tap to see in details) Author’s license agreement (public offer) on the publication of an article in a scholarly journal “Medical Journal of the Russian Federation” Eco-Vector, represented by its CEO Evgeniy Schepin and acting on the basis of the Charter (hereinafter referred to as the Publisher), on the one hand, offers an indefinite circle of persons (hereinafter referred to as the Author), and on the other hand, hereinafter jointly referred to as the Parties, to execute this agreement (hereinafter referred to as the Agreement) on the publication of scientific article (hereinafter referred to as the Article) in a scholarly journal “Medical Journal of the Russian Federation” (further-the Journal) in accordance with the conditions stated below. I. 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Affective disorders accompanied by cognitive disorders in inpatients with cardiovascular diseases: a clinical and pathopsychological study
BACKGROUND: The multimorbidity of affective, cognitive, and cardiovascular diseases is an urgent issue of the contemporary medicine due to their severity, resistance to therapy, social maladjustment, and low quality of life. Common pathogenetic mechanisms, including endothelial dysfunction and disorders of the frontal and subcortical connections, enhance these conditions, increasing the risks of dementia and mortality. AIM: To study the clinical and psychopathological structure of affective disorders and comorbid cognitive disorders in inpatients with cardiovascular diseases in various age groups. METHODS: An observational, single-center study was conducted from January 2023 to June 2024 at the University Clinic of the Russian University of Medicine. The study involved 121 patients with cardiovascular diseases and non-psychotic mental disorders, including 47 (38.8%) with comorbid affective and cognitive disorders. The patients were divided into three age groups, 45–59, 60–74, and 75–90 years. Clinical psychopathological and psychometric (Hospital Anxiety and Depression Scale, Montreal Cognitive Assessment) and neuropsychological methods (clock drawing test, Luria’s method) were used. Statistical analysis was performed using Fisher’s exact test and Student’s t-test. RESULTS: In 85.1% of patients, we detected organic emotional disorders, mainly with alarming symptoms. Significant differences in the clinical structure of affective disorders between the groups indicate age-related differences (p = 0.045). Cognitive disorders (visual and constructional praxis, attention, memory, abstract thinking) are associated with vascular changes and dysfunction of the frontal lobes. The Montreal Cognitive Assessment scores were in the range of 18–27; the average score in the 45–59 group (24.9 ± 0.3) was higher compared to the 60–74 (23.5 ± 0.2; p < 0.05) and 75–90 groups (23.4 ± 0.3; p < 0.05). Moderate cognitive disorders were detected in 55.3% of cases, severe cognitive disorders were detected in 19.2% of cases, and 25.5% of cases were within the normal range. Subjective cognitive complaints related to the risk of dementia were not confirmed by tests in 27.6% of cases. Attention and abstract thinking disorders increased with age (p < 0.05); whereas speech disorders showed no significant differences (p > 0.05). CONCLUSION: The study highlights the importance of early diagnosis and an interdisciplinary approach to multimorbid conditions and a qualitative analysis of the psychopathological and pathopsychological structure of affective and cognitive disorders in cardiovascular cases. The limitation is the small sample size, requiring further research on a larger sample of patients.
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Clinical and functional model of patients with a stroke under the International classification of functioning, disability and health as a basis for personalized rehabilitation
BACKGROUND: Stroke is a pressing healthcare and social issue. The treatment and rehabilitation outcome relies on a comprehensive approach and an individual medical rehabilitation (MR) plan based on the clinical manifestations and functional status of the patient. Diverse symptoms caused by variable brain damage and individual characteristics require medical decisions to improve MR programs. The clinical and functional patient model based on the biopsychosocial approach is the basis for the classification of health and improved MR programs. AIM: To develop clinical and functional rehabilitation models for patients with a stroke based on the International Classification of Functioning, Disability and Health (ICF) for the further development of a personalized MR plan. METHODS: A single-center, prospective, cohort, continuous uncontrolled study was conducted at the Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine named after S.I. Spasokukotsky of Moscow Healthcare Department. The study included 957 patients with ischemic stroke. Stage 1 involved the clinical and functional evaluation of patients with ischemic stroke according to the International Classification of Diseases, 10th Revision, and the ICF classification. Stage 2 involved the development of clinical and functional models of patients with a stroke. We conducted a clinical examination; the assessment was made using standardized scales and questionnaires and ICF domains. RESULTS: The study identified the most common patterns of dysfunction and performance impairment in patients with ischemic stroke. The most relevant ICF domains were analyzed to describe each model. Nine clinical and functional models of patients with a stroke were developed based on clinical evidence and ICF. Each model has a set of functional disorders (predominant dysfunction of the upper limb, predominant dysfunction of the lower limb, and coexistent disorders) grouped by severity (mild, moderate, and severe). CONCLUSION: Clinical and functional models of patients with a stroke based on the clinical manifestations and ICF functional status allows developing a personalized MR program for optimal recovery and improved quality of life. Further development of the methodology for personalization of model formation will allow to improve rehabilitation programs and outcomes in patients with a stroke.
Study of correlations between on-ice test performance and heart rate variability in ice hockey defensemen
BACKGROUND: Heart rate variability indicators in ice hockey athletes have been explored very poorly thus far. Investigating correlations between the indicators of heart rate variability and on-ice testing (the most efficient method for assessing special work capacity, energy supply, and adaptation of ice hockey players) is highly crucial given the labor intensity, high cost, and invasiveness of on-ice testing. AIM: To study heart rate variability indicators in ice hockey defensemen during on-ice tests and to identify correlations between the metrics resulting from the examination using two methods. METHODS: The study involved ten defensemen from a major league hockey team aged between 19 and 34 during the season of play. The study methods included: pulse measurement using the PolarTeamPro2 team system; determination of lactic acid content in blood using a photometric method; estimation of special work capacity, energy supply, and blood buffer capacity of players through on-ice testing; 5-minute rhythmocardiography using the KFS-01.001 Cardiometer-MT electrocardiograph (MIKARD-LANA, Russia). Results data were statistically processed using the Excel-2017 software. RESULTS: Seven out of ten athletes (70%) had type 3 heart rate regulation according to Shlyk’s classification. Based on the median spectral indicators, it turned out that the central heart rate regulation circuit (low-frequency waves and very low-frequency waves) was dominant in defensemen. The total wave spectrum growth significantly correlated with the heart rate recovery indicators in the sample of defensemen (the correlation coefficient was −0.69) and suggested that the characteristics of the defensemen were close to the model characteristics of on-ice testing (correlation coefficient of 0.689). The value of the parasympathetic component of the wave spectrum (high-frequency waves) significantly negatively correlated with the test completion time (correlation coefficient of −0.48) (special work capacity) and blood lactate in on-ice testing (correlation coefficient of 0.515). CONCLUSION: Improvements in the cardiovascular system’s adaptation to special ice work and the approximation of defensemen’s characteristics to model characteristics are closely related to an increase in overall heart rate variability and the central heart rate regulation circuit. The dynamics of heart rate variability indicators can be used as an operational control over ice hockey defensemen.
Chronic heart failure with preserved ejection fraction after myocardial infarction: are beta-antagonists necessary? A two-year prospective study
BACKGROUND: Advances in the diagnosis and treatment of myocardial infarction have triggered an ≥50% increase in the proportion of patients with preserved left ventricular ejection fraction. The relevance of using adrenergic beta-antagonists in this patient cohort remains a topic of active debate. AIM: To study the two-year catamnesis of patients suffering from myocardial infarction with chronic heart failure and preserved left ventricular ejection fraction who either received or did not receive adrenergic beta-antagonists. METHODS: The study encompassed 127 patients with myocardial infarction aged 53 (48; 60) years with preserved left ventricular ejection fraction. On days 4–9 of myocardial infarction and on its 12- and 24-month anniversary, echocardiography with assessment of global longitudinal strain, longitudinal electrocardiogram monitoring, measurement of N-terminal natriuretic hormone peptide concentration, and a 6-minute walk test were performed. The endpoint was chronic heart failure progression over subsequent 2 years. RESULTS: The adrenergic beta-antagonist group included 98 patients (77%) who received adrenergic beta-antagonist therapy, whereas the remaining 29 patients (23%) who did not receive such therapy due to hypotension and bradycardia made up the no adrenergic beta-antagonist group. In the adrenergic beta-antagonist group, by the second year of the post-infarction period, there was an increase in the indexed values of end-diastolic and end-systolic volumes, a decrease in left ventricular ejection fraction by 3.1% (р = 0.00077) and global longitudinal strain by 2.4% (р = 0.0002); in the other group, these parameters remained flat. In patients of the adrenergic beta-antagonist group, a decrease in chronotropic load on the myocardium and an increase in the circadian index while maintaining its rigid level were recorded; in the no adrenergic beta-antagonist group of patients, an increase in chronotropic load and normalization of the circadian heart rhythm profile were observed as early as by the 12th month of observation. The number of patients with progressive chronic heart failure over 2 years of observation in both groups did not differ: 21% and 24%, respectively (the risk ratio is 0.659; the 95% confidence interval is 0.35–1.243). CONCLUSION: In today’s context, with the use of reperfusion methods for treating patients with myocardial infarction, it is necessary to conduct large-scale randomized clinical trials studying the effect of adrenergic beta-antagonist therapy on the prognosis in patients with preserved left ventricular ejection fraction. According to the results of this study, no significant differences were found in the frequency of progression of chronic heart failure in groups of patients who had suffered myocardial infarction and preserved left ventricular ejection fraction. In the group of patients who did not receive adrenergic beta-antagonists, more stable myocardial volume and deformation characteristics were observed within 24 months of myocardial infarction.
The role of gut microbiota and vitamin D in the development of atopic dermatitis and food allergies in children
BACKGROUND: Gut microbiota and vitamin D may be instrumental in the development of atopic responses (atopic dermatitis, allergic rhinitis, allergic asthma, and food allergies) in children. Various diseases or immune pathologies, in particular atopic dermatitis and food allergies, are among manifestations of an imbalance in the composition of gut microorganisms. On top of that, vitamin D is a significant contributor both to modulating the gut microbiome composition and to diverse immune responses from innate and adaptive immunity, which affords ground for studying the relationship between these aspects in the context of the development of atopic conditions. So far, the relationship between the gut microbiota, vitamin D, and the development of these conditions in children has not been sufficiently explored. AIM: To study the relationship between the gut microbiota imbalance and immune disorders, in particular the development of food allergies and atopic dermatitis in children; to identify the relationship between bacterial signatures and vitamin D concentrations in children with atopic dermatitis and food allergies. METHODS: The 16S ribosomal ribonucleic acid gene of 150 fecal samples from children aged 3 to 12 years was sequenced. The concentration of vitamin D in the participants’ blood serum was determined using enzyme-linked immunosorbent assay. Thereafter, the relationship between certain bacterial signatures and serum 25(OH)D concentration was characterized through the use of statistical models (regression tree, correlation analysis, and linear regression). RESULTS: In all mathematical models used, vitamin D concentration turned out to be associated with bacterial families important for atopy, such as Lachnospiraceae, Ruminococcaceae, and Sutterellaceae. The results showed that dysbiosis coupled with vitamin D deficiency is typical of the atopic profile, which may indicate the influence of these conditions on the immune system imbalance toward the Th2 response and, consequently, on the development of allergic conditions. CONCLUSION: Certain bacterial patterns specific to atopy are associated with vitamin D concentration in blood serum. In consequence of the study, we concluded that the gut microbiota and vitamin D may be systematically involved in modulating immune responses. Further research is needed to attain full comprehension of the mechanisms underlying these associations and to determine the most efficient interventions for the prevention and treatment of autoimmune conditions.
Injuries characteristic of accidents involving personal mobility devices
BACKGROUND: Personal mobility devices (PMDs) are rapidly increasing urban traffic. From 2020 to 2024, in Russia, the fleet of electric scooters grew more than 10-fold, the number of users increased 14-fold, and the number of trips increased 26-fold. This growth is related to a significant increase in injuries. In the first 9 months of 2024, the number of recorded road accidents involving PMDs reached 3,897 with 4,052 people injured and 44 people killed (an increase of 837, 825, or 340%, compared to 2021). Despite its relevance, systematic data on types of injuries and risk factors are limited as the State Traffic Safety Inspectorate only records injuries involving PMDs in cases of PMD collisions with motor vehicles or causing serious bodily harm. Cases of a person falling from a scooter are maintained in the medical record only. AIM: To study the characteristics of PMD-related injuries and to analyze the medical and social aspects of this issue in order to develop comprehensive steps to prevent PMD-related injuries. METHODS: We conducted a retrospective continuous study of 170 medical records of adult patients (aged ≥ 18 years) admitted to the City Clinical Hospital No. 1 named after N.I. Pirogov from May 2021 to May 2025 for injuries sustained while using electric scooters, unicycles, gyro scooters, or segways. The type of injury was verified by X-ray imaging and computed tomography or magnetic resonance imaging (if necessary); severity was assessed using the Injury Severity Score. Statistical analysis was performed using Statistica 13.5. RESULTS: Most patients with PMD-related injuries were admitted in the autumn and spring. The examined injured individuals were predominantly males (121, or 71.1%) aged 25 to 44 years (117, or 68.8%). The Injury Severity Scale showed that most injuries were minor with the score of 4 [4; 9]. Analysis of data from 170 patients showed 262 traumatic injuries. The structure of injuries was dominated by upper limb injuries (108 cases, or 41.2%), lower limb injuries (88 cases, or 33.6%), chest injuries (12 cases, or 4.6%), and wounds and bruises (54 cases, or 20.6%). Multiple limb injuries were diagnosed in 40 patients (23.5%) and combined craniocerebral and craniofacial injuries were diagnosed in 127 patients (74.6%). In the majority of cases (162, or 93.8%), fractures required surgical intervention. CONCLUSION: A retrospective analysis of 170 inpatient cases confirmed that PMD-related injuries is an independent clinical and epidemiology category: 95.9% of cases are related to the use of electric scooters, mainly by males aged 25–44 years, with a median Injury Severity Scale score of 4, osteosynthesis was required in 95.3% of patients, and mild traumatic brain injury was recorded in 74.7%.
Questionnaires for screening relative energy deficiency in sport (RED-S) in women: a systematic review
BACKGROUND: Relative energy deficiency in sport (RED-S) and low energy availability are major issues in modern sports. The constant prevalence of energy expenditure on training and competition over energy intake is the main risk factor for these conditions to occur. Quantifying energy deficiency in everyday practice is rendered difficult, but questionnaires can be an effective tool for timely screening of low energy availability and RED-S. AIM: To conduct a systematic review of questionnaires used to assess RED-S risk factors in athletes. METHODS: The presented review was conducted in concert with the methodological guidelines found in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. A search was conducted through the PubMed, Google Scholar, Embase, Scopus, CINAHL, Medline Ovid, and SPORTDiscus electronic databases from January 2010 to February 2025. The review covered articles setting forth issues regarding the assessment of reproductive health and manifestations of RED-S. RESULTS: Out of the 29 studies included in the review, ten unique questionnaires were found to identify athletes at risk of energy deficiency. Nine questionnaires were validated, three of which included only screening for eating disorders, without assessing other symptoms or training activity. Two questionnaires were most frequently used in studies and practice: the low energy availability in females questionnaire and the eating disorder examination questionnaire. CONCLUSION: Questionnaires can be effective in identifying intentional energy restriction, early detection of gynecological pathology, and the risk of energy deficiency in female athletes. Questionnaires are screening tools but not methods for diagnosing RED-S.
Structural and functional changes in right heart in patients with obstructive sleep apnea syndrome
Obstructive sleep apnea syndrome is a common condition in the global population. Despite its relatively short history of study, there has been accumulated sufficient evidence of its negative influence on the cardiovascular system. However, the condition of the right heart chambers and the development of pulmonary hypertension in this patient cohort often remain outside the focus due to disturbed hemodynamics in the pulmonary circulation system. Diagnosis of right heart involvement in patients with obstructive sleep apnea syndrome is challenging as there is no specific clinical manifestations and such patients have multiple comorbidities. The aim of this review article is to describe original studies and meta-analyses dedicated to examining the structures and functions of the right heart chambers and to attempt to highlight the multifaceted nature of pulmonary hypertension diagnosis in patients with obstructive sleep apnea syndrome. The literature review was conducted using medical abstract databases PubMed (MEDLINE), ScienceDirect, and eLIBRARY.RU.
Role of microbiota in development of type 2 diabetes mellitus: pathogenesis and treatment landscape
The gut microbiota is a complex of microorganisms, mainly bacteria, inhabiting the human intestines. Microorganisms of the intestinal microflora influence metabolism, immunological reactivity, and pathogenesis of various diseases, such as diabetes mellitus, obesity, inflammatory bowel diseases, and others. This article examines the influence of intestinal microflora on the development of type 2 diabetes mellitus and its treatment options. A review of publications shows that microbiota imbalance may be associated with various metabolic disorders, which is confirmed by many studies. Active metabolites affecting the development of type 2 diabetes mellitus include short-chain fatty acids, imidazole propionate, trimethylamine N-oxide, branched-chain amino acids, and tryptophan metabolites. These compounds can affect the metabolic processes in the body, including insulin sensitivity, inflammatory reactions, and glucose metabolism, which may eventually contribute to the development of type 2 diabetes mellitus. Studying the interaction of the gut microbiota with drugs is challenging as the underlying biological mechanisms are not fully understood. The key discussed aspects also include the contemporary treatment landscape of type 2 diabetes mellitus associated with the microbiome, namely the use of metformin as a sugar-lowering drug; the use of pro- and prebiotics; dietary and lifestyle interventions; fecal microbiota transplantation, and smoking cessation. All these treatment options show ability in controlling microbiota to manage the disease and improve therapy outcomes. Further research in this area opens up opportunities for the development of innovative treatment strategies for type 2 diabetes mellitus focused on the health of the intestinal microflora. Understanding the impact of microbiota on metabolic disorders will help to develop personalized treatment approaches and lead to improved health in patients with type 2 diabetes mellitus.
Relationship between Crohn’s disease and gut microbiota in the elderly: a literature review
Crohn disease is a chronic inflammatory disease of the gastrointestinal tract that develops as a result of complex interaction between the immune system and the gut microbiota. The incidence of the disease has recently increased, especially in the young and elderly population. This article examines current data on microbiota changes in patients with Crohn disease with an emphasis on the elderly population and the influence of the intestinal microflora composition on the disease course. An analysis of literature over the past 5 years from scientific databases, such as Medline, PubMed Central, eLIBRARY.RU, and Cyberleninka, has shown that the intestinal dysbiosis characteristic of the majority of patients with Crohn disease leads to a decrease in bacterial diversity and excessive growth of pathogenic microorganisms. In addition to the bacterial flora, an important role in the pathogenesis and course of the disease play fungi, viruses, and parasites, which is directly related to the worsening of the condition. The findings emphasize the importance of studying the role of microbiota in the development and course of the disease, which may contribute to the development of new treatment and prevention options.