HERALD of North-Western State Medical University named after I.I. Mechnikov
Journal: Рeer-review medical academic journal
History: publishes from 2009
The target audience of a peer-reviewed journal "HERALD of North-Western State Medical University named after I.I. Mechnikov" is faculty members of medical universities and institutions of additional professional education, for research staff, as well as for practitioners of various specializations.
The "HERALD of North-Western State Medical University named after I.I. Mechnikov" publishes original articles written by experts of different fields of clinical and preventive medicine, public health, biomedical and pharmaceutical sciences, scientific lectures, scientific reviews and discussions, as well as highlights various issues concerning the advanced training of practitioners.
The Editorial board cooperates with the faculty members of the leading research institutes and medical schools of Russia.
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Vol 16, No 4 (2024)
- Year: 2024
- Articles: 14
- URL: https://journal-vniispk.ru/vszgmu/issue/view/18051
Reviews
Heart failure and netosis: a modern view of pathophysiology and treatment methods
Abstract
Over the past 20 years, the prevalence of chronic cardiac insufficiency in the Russian Federation has increased from 6.1 to 8.2%. Chronic, mild inflammation is also one of the main factors affecting the development and progression of chronic cardiac insufficiency. The purpose of the review is to analyze the literature data on the role of netosis in the pathogenesis of chronic cardiac insufficiency, as well as to consider new potential possibilities of chronic cardiac insufficiency therapy. As a result of the research search, 3366 publications were extracted from PubMed and 2223 publications found using Google Scholar. The search queries included the following keywords and their combinations: “netosis”, “neutrophil extracellular traps”, “NET”, “heart failure”, “myocardial infarction”, “atrial fibrillation”, “coronary heart disease”, “myocarditis”. The mechanisms of neutrophil extracellular traps formation and their contribution to the development of chronic cardiac insufficiency certainly require further study. In particular, the direct role of netosis in the development of fibrosis, hypertrophy and dysfunction of the left ventricle is still unknown. However, recent genetic and pharmacological studies show that inhibitors of myeloperoxidase, neutrophil elastase and peptidylargine deiminase can be effective, at least in chronic cardiac insufficiency in conditions of unfavorable remodeling after myocardial infarction, heart valve diseases and decompensated ventricular hypertrophy, the deterioration of which leads to the development of chronic cardiac insufficiency. These results are important for understanding the role of netosis in the pathophysiology of chronic cardiac insufficiency and developing new methods of its treatment.
5-18
The current state of the issue of drug-induced hypoprolactinemia
Abstract
Hypoprolactinemia is the least studied hormonal deficiency of the anterior pituitary gland. To date, most studies have been devoted to hyperprolactinemia, and there is practically no data on it in the Russian literature.
The purpose of the review is to analyze current literature data on drug–induced hypoprolactinemia and its clinical consequences.
The following keywords and their combinations in Russian and English were used for the search: “hypoprolactinemia”, “drug-induced hypoprolactinemia”, “pituitary gland”, “adenoma”, “prolactinoma”, “dopamine receptor agonists”, “antipsychotic drugs”. As a result of the selection, 82 studies were included in the review.
Human prolactin is a multifunctional hormone that performs many tasks besides stimulating lactation. Unlike hyperprolactinemia, which is characterized by a clear clinical phenotype and the availability of treatment recommendations, the studies of hypoprolactinemia are relatively new. Modern ideas about the ideal level of prolactin in men and women remain incomplete. Drug-induced hypoprolactinemia is usually determined based on the lower limit of the reference values based on the results of tests and can be detected by various specialists, including endocrinologists, therapists, psychologists and psychiatrists. This problem opens up opportunities for interdisciplinary collaboration. Patients with hypoprolactinemia need to be monitored for metabolic, cardiovascular, psychological and sexual disorders.
19-34
Original research
The effect of proprotein convertase subtilisin kexin type 9 inhibitors on the survival of patients at extreme cardiovascular risk in real clinical practice
Abstract
BACKGROUND: Among non-communicable diseases, cardiovascular diseases occupy a leading position in terms of mortality rate in developed countries, including Russia. In the clinical practice of the Russian Federation, almost all modern methods and means of treating patients with cardiovascular diseases are used. In particular, innovative lipid-lowering drugs are used, such as proprotein convertase inhibitors subtilisin/kexin type 9 — alirocumab and evolocumab. However, at the moment there is no complete information on how these drugs affect the survival of patients at extreme cardiovascular risk, both worldwide and in Russia. In this regard, the study of this issue is an important and urgent task.
AIM: To evaluate the efficacy and safety of proprotein convertase inhibitors subtilisin / kexin type 9 in patients at extreme cardiovascular risk. Also, to assess the effect of these drugs on the survival of patients of this category of cardiovascular risk.
MATERIAL AND METHODS: The study involved 104 patients at extreme cardiovascular risk. The patients were divided into two groups: the main group (53 people) and the control group (51 people). In the control group, the patients received standard lipid-lowering therapy: statin at the maximum tolerated dosage and/or ezetimibe, and in the main group, standard lipid-lowering therapy was supplemented with drugs of proprotein convertase inhibitors subtilisin/kexin type 9.
The results of laboratory research methods were analyzed in dynamics, and the frequency of side effects was evaluated. All cases of cardiovascular events, including mortality, were recorded. Based on the data obtained, we analyzed the survival rate and frequency of major cardiovascular events.
RESULTS: In the main group, month after starting therapy with proprotein convertase inhibitors subtilisin/kexin type 9, the level of low-density lipoproteins in all the patients decreased by more than 50% from the initial value. The target level of low-density lipoproteins was reached by 42 out of 53 observed patients. These results remained stable until the end of the study. No cases of hepatotoxicity, myopathy, or other local side effects were reported during the period of use of proprotein convertase inhibitors subtilisin/kexin type 9. In the control group, the lipidogram of patients did not change significantly during the study. In addition, there were more cases of recurrent cardiovascular events, including mortality, in the patients in the control group.
CONCLUSIONS: In real clinical practice, proprotein convertase inhibitors subtilisin / kexin type 9 has demonstrated high efficacy and safety in patients at extreme cardiovascular risk. Thanks to the use of these drugs, it was possible to achieve the target levels of low-density lipoproteins and increase patient’s adherence to treatment. As a result, the prognosis for patients with an extreme risk of cardiovascular complications improved.
35-44
The influence of controlled risk factors on the development of caries in young children
Abstract
BACKGROUND: The prevalence of caries is of high importance in childhood. In the structure of the intensity of caries, cavity carious lesions predominate and account for about 80%. Due to the large number of risk factors for early childhood caries, it is customary to divide them into groups related to the type of feeding, violation of the regime and nature of nutrition (frequency, amount and duration of sugar consumption), oral hygiene, bacterial flora of the oral cavity. Considering the influence of risk factors with the eruption of the first teeth, it is necessary to note first of all the type of feeding and its duration, oral hygiene with the appearance of the first tooth.
AIM: The aim is to study the dental morbidity of children from 1 to 3 years old and to determine the statistical significance of controlled risk factors for the development of early childhood caries on the basis of clinical and sociological (survey) studies.
MATERIALS AND METHODS: Clinical dental examination of 358 children aged from 1 to 3 years was carried out. The examination of children was carried out under standard conditions: in a dental chair, under artificial lighting, in the patient’s sitting position. A visual examination method using a dental mirror was used for the examination. Of the 358 examined children of this age group, two groups were identified: group 1 have carious lesions of the teeth (100 children), group 2 — do not have dental caries (256 children).
A survey among the parents of the examined children found out the course of pregnancy, the presence of somatic pathology in the child, the type of feeding of the child, the duration of natural feeding, the nature of the first complementary feeding, the intake of the first sweet drink, the frequency of carbohydrate intake, the beginning of the oral cavity care and the frequency of brushing the teeth.
RESULTS: The clinical examination of the children under the age of 3 years (356 children) obtained the following indicators: the average prevalence of early childhood caries in the examined group of children was 28%, and the average value of the index of intensity of temporary teeth caries was 2.14 ± 0.06, with 79.4% of carious teeth, and 20.6% of filled teeth. The type of feeding, the duration of natural feeding, the type of first complementary feeding, factors related to the use of carbohydrates and hygienic care of the child’s teeth have significant influence on the occurrence of early childhood caries.
CONCLUSIONS: The influence of these factors is easily minimized or eliminated with the help of sanitary and educational work of pediatric dentists and pediatricians even in the first month of a child’s life. Using computer programs that determine the prognosis and clearly demonstrate the problems to dentists and parents, it is assumed that it is possible to compile personalized measures for the treatment and prevention of early carious lesions, taking into account one of the early risk factors for the development of caries associated with nutrition.
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The experience of using succinate-containing crystalloid solution in the correction of COVID-19-associated endotheliopathy
Abstract
BACKGROUND: Early experience with succinate-containing agents has demonstrated their effectiveness in controlling COVID-19-related systemic disease and coagulopathy. The work is aimed at studying the possibilities of infusion correction of COVID-19-associated endotheliopathy.
AIM: To evaluate the effect of using meglumine sodium succinate 1.5% solution on the severity of COVID-19-associated endotheliopathy in patients with severe coronavirus infection.
MATERIALS AND METHODS: Clinical and laboratory parameters of 53 patients in the intensive care unit with COVID-19 complicated by community-acquired bilateral polysegmental pneumonia were analyzed. The intensive care package for 27 patients (study group) included a daily infusion of a 1.5% solution of meglumine sodium succinate (Reamberin) in a daily dose of up to 10 ml/kg for a course of at least 11 days or during the entire stay in the department. The control group, which included 26 patients, received a similar volume of Ringer’s solution. At all stages of the study, the level of endotheliocytosis, homocysteine, fibrinogen, activated partial thromboplastin time, platelet count, and antithrombin III was determined.
RESULTS: Assessment of the degree of endotheliopathy in the meglumine succinate group showed a significant decrease in the initially elevated levels of endothelemia and homocysteinemia at all stages of the study. The pattern of changes in the study group highly correlated (r values were in the range 0.90–0.96) with the dynamics of fibrinogenemia, platelet levels, and antithrombin III.
CONCLUSIONS: The use of a succinate-containing infusion solution in patients with a new coronavirus infection promotes a more rapid and sustainable correction of COVID-19-associated endotheliopathy, which, in turn, is manifested by a decrease in the levels of endotheliocytosis, secondary markers of endotheliopathy, a platelet-protective effect and a decrease in heparin resistance.
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The steroid metabolism exploration for the diagnosis of Connshing syndrome
Abstract
BACKGROUND: Reports of the synchronous glucocorticoid-mineralocorticoid activity in patients with Cushing’s syndrome and primary hyperaldosteronism have been found in the literature for fifty years, but there are few evidence-based studies on this issue.
AIM: To study mineralocorticoid and glucocorticoid secretion in patients with unilateral, bilateral tumours and bilateral hyperplasia of the adrenal cortex exploring urine and blood steroid metabolomes by chromatography methods.
MATERIALS AND METHODS: 114 patients with corticotrophin-independent Cushing’s syndrome, autonomous cortisol secretion and primary hyperaldosteronism were examined. The state of the pituitary-adrenal cortex system was assessed by classical methods of immunochemical analysis and functional tests. The corticosteroid metabolomics was studied in biological fluids using high-performance liquid chromatography and gas chromatography-mass spectrometry. In accordance with functional activities and type of hyperplasia, all the patients were divided into 8 subgroups: Cushing’s syndrome and corticosteroma (n = 19), Cushing’s syndrome and bilateral adenomas (n = 9), Cushing’s syndrome and bilateral macronodular hyperplasia (n = 8); autonomus cortisol secretion and unilateral adrenal adenoma (n = 19), autonomus cortisol secretion and bilateral adenomas (n = 14) and autonomus cortisol secretion with bilateral macronodular hyperplasia (n = 11); primary hyperaldosteronism with unilateral aldosteroneproducing adrenal adenoma (n = 15) and bilateral hyperplasia (n = 19). The group of healthy subjects was a control group (n = 22). Family hyperaldosteronism and adrenocortical cancer were excluded. Patients’ urinary corticosteroid excretion and blood steroid levels were compared using the nonparametric Mann–Whitney test.
RESULTS: Chromatographic methods have shown the presence of mineralocorticoid and glucocorticoid co-secretion in the patients with primary hyperaldosteronism: increased urine excretion of free cortisol 51 (27–90) ng/ml (p = 0.001) and its metabolite tetrahydrocortisol — 850 (720–994) μg/24 h (p = 0.0002) in the patients with Conn syndrome. As well as free cortisol 35 (32–72) µg/24 h (p = 0.002), tetrahydrocortisol — 1036 (490–1482) µg/24 h (p = 0.0049), 5α-tetrahydrocortisol — 1194 (411–1873) µg/24 h (p = 0.0048), 5α-tetrahydrocorticosterone — 339 (172–356) µg/24 h (p = 0.0008) in the patients with bilateral adrenal hyperplasia and hyperaldosteronism in comparison with the healthy persons. Glucocorticoid-mineralcorticoid activity was found among the patients with autonomous cortisol secretion and bilateral adrenal tumours: by increased levels of 18-hydroxycorticosterone in blood — 2.7 (1.3–3.5) ng/ml (p = 0.002). The patients with autonomous cortisol secretion and a single tumour had an increase of 18-hydroxycorticosterone in urine — 35 (33–55) µg/24 h (p = 0.0048) in comparison with the healthy subjects. The group of patients with corticotrophin-independent Cushing’s syndrome and unilateral corticosteroma was distinguished from the control group by high level of 18-hydroxycorticosterone in blood — 2.4 (1.0–4.3) ng/ml (p = 0.001) and urine — 42 (30–123) µg/24 h (p = 0.003).
CONCLUSIONS: Mixed glucocorticoid and mineralocorticoid activity of adrenal cortical tumor cells was revealed among the patients with Cushing’s syndrome, with autonomous cortisol secretion and primary hyperaldosteronism using chromatographic methods.
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Capsular contracture in the modern era of combined breast cancer treatment: a multidisciplinary perspective on incidence and risk factors
Abstract
BACKGROUND: Implant-based breast reconstruction in contrast to autologous reconstruction often requires revision surgery and ultimately leads to reconstructive failure, especially in adjuvant radiation therapy. Capsular contracture remains the most common complication leading to unsatisfactory aesthetic results. To date, there is no therapeutic target for the direct treatment of capsular contracture, which emphasizes the importance of its prevention.
AIM: To determine the incidence and risk factors of capsular contracture in the era of multidisciplinary breast cancer treatment using modern surgical and therapeutic approaches.
MATERIALS AND METHODS: The following retrospective study included 416 patients after mastectomy with immediate or delayed implant-based breast reconstruction in combination with adjuvant radiation therapy. Features of the surgical intervention, neoadjuvant and/or adjuvant systemic therapy were analyzed to determine the association with the risk of developing capsular contracture.
RESULTS: Capsular contracture during alloplastic reconstructive plastic surgery with adjuvant radiation therapy, according to the literature, is a common complication with a complex and multifactorial pathogenesis. Despite the low incidence of capsular contracture III–IV Baker scale in the present study (7.7%, 32/416), the majority of patients required revision surgery (90.6%, 29/32). There was no correlation between risk of capsular contracture depending on the systemic treatment (z < 1.96).
CONCLUSIONS: The development of capsular contracture was significantly influenced by nipple-sparing mastectomy (13.7%, 22/167; z = 3.25) and the choice of periareolar access during surgery (29.6%, 13/44; z > 1.96). Immediate one-stage reconstructions are associated with a significant number of capsular contractures (15.2%, 24/158; z > 1.96), which statistically significantly depend on the subpectoral location of the endoprosthesis (22.1%, 21/95; z = 2.79) and choice of textured implants (20.8%, 22/106; z = 2.02).
74-85
Subclinical hypothyroidism — an unexpected ally in the fight against sarcopenia
Abstract
BACKGROUND: Thyroid hormones are essential for maintaining metabolism involved in regulating growth and development. Skeletal muscles are their primary target organ, and thyroid hormone signaling plays a role in the development, plasticity, and regeneration of skeletal muscles. Conditions such as hypo- and hyperthyroidism negatively affect the state of this tissue. However, in our earlier studies, bigger volume of thigh muscle was found to be one of the factors associated with lower mortality in individuals with high levels of thyroid-stimulating hormone.
AIM: To evaluate the impact of function thyroid gland on the risk of decreased volume of thigh muscles in older adults.
MATERIALS AND METHODS: This study was carried out on the basis of the second examination of the Crystal study of community-dwelling individuals 65+ (n = 383). The main study parameters involved thyroid-stimulating hormone, thigh muscle volume, complete blood count test, CRP, comprehensive geriatric assessment, non-communicable chronic diseases.
RESULTS: Compared with the participants with thyroid-stimulating hormone levels between 3.3 and 10.0 mIU/L, the participants with thyroid-stimulating hormone levels <0.2 mIU/L and the participants with thyroid-stimulating hormone levels between 0.2 and 3.2 mIU/L had lower body mass index, thigh muscle volume and the high prevalence of autonomy decline (p < 0.05). Even after adjusting for sex, age, malnutrition, body mass index, and autonomy decline, high thyroid-stimulating hormone levels were associated with bigger thigh muscle volume, with an odds ratio (95% confidence interval) of 3.274 (1.111–9.647).
CONCLUSIONS: The thyroid-stimulating hormone levels from 3.3 to 10.0 mIU/L increases the chances of maintaining bigger thigh muscle volume in older adults by 3.3 times.
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Experimental assessment of the neurotoxicity of antitumor drugs in Danio rerio fish
Abstract
BACKGROUND: Neurotoxicity is one of the specific complications of antitumor therapy, which is a serious problem both during the therapy itself and when creating models for its study. Behavioral tests on Danio rerio fish act as an excellent model for creating neurotoxicity and allow to evaluate it in the shortest possible time.
AIM: To evaluate the neurotoxic properties of the anticancer drugs doxorubicin and oxaliplatin on Danio rerio (zebrafish) fish through behavioral tests and their evaluation using a program for manual processing of animal behavior.
MATERIALS AND METHODS: 45 adult Danio rerio fish were used in the study. Three groups were formed: control group (n = 15), experimental group No. 1 (n = 15) — doxorubicin, experimental group No. 2 (n = 15) — oxaliplatin. A specific dose of the drug was selected for each experimental group. After completing the course of drugs, behavioral tests were conducted, which were recorded on a video camera and processed in the RealTimer application. All tests were repeated three days later to detect reversible neurotoxicity.
RESULTS: As a result of the effects of the antitumor drugs doxorubicin and oxaliplatin on Danio rerio fish, neurotoxic abnormalities were detected, which were noticed during behavioral tests: “Social interaction”, “Social preference” and “Aggression”. In the case of doxorubicin, the fish showed severe irritability and high activity, while the fish treated with oxaliplatin showed inhibition and frequent cases of freezing.
CONCLUSIONS: During the experiment, a new model was developed and tested to study the neurotoxicity of antitumor drugs on Danio rerio (zebrafish) fish. In addition to confirming the neurotoxicity of antitumor drugs, reversible nephrotoxicity of oxaliplatin was obtained. The study showed the possibility of using the program to evaluate test results in Danio rerio (zebrafish) fish.
94-103
Efficacy of conservative treatment of chronic multiple nonbacterial osteomyelitis in adults based on one-year follow-up results
Abstract
BACKGROUND: Chronic multiple nonbacterial osteomyelitis is an orthopaedic autoinflammatory disease of bones and joints of unclear aetiology, characterised by the formation of multiple foci of osteitis refractory to antibiotic therapy and surgical treatment, occurring predominantly before the age of 18 years. Data on the treatment of adult chronic multiple nonbacterial osteomyelitis are limited due to the orphan character of the disease and the rarity of its onset in adults.
AIM: To present data on the efficacy of conservative treatment of adult chronic multiple nonbacterial osteomyelitis after one-year follow-up.
MATERIALS AND METHODS: 12 patients aged 18 years and older with a histologically confirmed diagnosis of chronic multiple nonbacterial osteomyelitis were followed up. Clinical, demographic and laboratory data of the patients were recorded.
RESULTS: The sex and age structure of the studied group of the patients: 7 women (58.33%), 5 men (41.67%); the average age of the patients was 37.35 ± 15.5 years. Monofocal forms of chronic multiple nonbacterial osteomyelitis were observed in 8 cases (66.67%), multifocal – in 4 cases (33.33%). Drug therapy in the study group: all the patients (100%) received non-steroidal anti-inflammatory drugs, 3 patients (25.0%) received glucocorticosteroids per os; cytostatics – by 7 patients (58.33%), bisphosphonates – by 3 patients (25.0%), genetically engineered biological therapy – by 5 patients (41.67%). Therapeutic treatment of chronic multiple nonbacterial osteomyelitis was started after surgical treatment in 6 patients (50.0%); in 6 patients (50.0%) conservative treatment was prescribed immediately after diagnosis. The conservative treatment was effective: after the beginning of adequate drug therapy; no surgical reatment was performed; stable clinical and laboratory remission of the disease without relapses of osteitis was observed.
CONCLUSIONS: In a typical group of adult patients with chronic multiple nonbacterial osteomyelitis, conservative treatment with the use of immunosuppressive treatment allows to achieve control over the disease activity with the absence of osteitis recurrences during a year of observation.
104-110
Treatment of patients with periodontitis accompanied by halitosis with the use of bacterial drugs
Abstract
BACKGROUND: Chronic generalized periodontitis is often accompanied by halitosis (ozostomy), which has a significant impact on the psycho-emotional state, social status of patients and reduces their quality of life. Synbiotic complexes are able to selectively affect the pathogenic microbiota, reducing her activity, thereby eliminating the phenomena of ozostomy.
AIM: To evaluate the effectiveness of a synbiotic complex based on the lysate of Streptococcus thermophilus in the treatment of mild chronic generalized periodontitis accompanied by halitosis.
MATERIALS AND METHODS: 30 patients with chronic generalized periodontitis of mild severity and phenomena of halitosis were examined. The periodontal status was determined using Plaque Index, Papillary-marginal-alveolar Index, Sulcus Bleeding Index, and measuring the depth of periodontal pockets. The level of halitosis was determined by the method of organoleptic assessment of oral odor according to R. Seemann, a test with a floss and a napkin, a psychophysical assessment of odor according to the M. Rosenberg scale, the assessment of plaque on the tongue using the Winkel Tongue Coating Index. In the main group, complex treatment was performed with the inclusion of a synbiotic complex based on the lysate of Streptococcus thermophilus. The control group of the patients did not receive the synbiotic complex.
RESULTS: After the therapy, both groups showed an improvement in the condition of periodontal tissues, a decrease in the level of halitosis in the patients and a statistically significant change in the main clinical parameters studied. Moreover, in the patients of the main group, 3 months after the start of therapy, the degree of ozostomy was 2.8 times lower than in the control group.
CONCLUSIONS: The use of a synbiotic complex based on the lysate of the culture of Streptococcus thermophilus in the treatment of chronic generalized periodontitis of mild severity, accompanied by halitosis, increases the effectiveness of traditional therapy.
111-117
Analysis of treatment outcomes in patients with colorectal cancer in 2015 and 2022
Abstract
BACKGROUND: The surgical management of colorectal cancer remains an urgent problem. In the surgical treatment of patients with colorectal cancer, reducing the incidence of anastomotic leakage, the length of hospital stay and improving the prognosis of the disease are of great importance.
AIM: To compare the results of treatment of patients with colorectal cancer before and after the introduction into clinical practice of optimisation methods adopted in the clinics of the Department of Hospital Surgery named after V.A. Oppel.
MATERIALS AND METHODS: The analysis of treatment outcomes in 101 patients who underwent surgery for colorectal cancer in the Clinic of Hospital Surgery named after. V.A. Oppel, North-Western State Medical University named after I.I. Mechnikov in 2015 and 2022. All the patients were divided into 2 groups: in 2022 the study included 57 patients, who made up group A; in 2015, the clinic treated 44 patients, who were included in group B. The largest number of patients in both groups had stage II of the disease: in group A — 31 patients (54%), in group B — 19 patients (43%).
RESULTS: The average length of hospital stay was 12.16 days in 2022, in 2015 — 15.95 days in the patients with uncomplicated postoperative period; with the development of postoperative complications, the hospital stay reached 31 days. The share of laparoscopic surgery in 2015 was 47.7%. In 2022 it was 74.1%. In 2022, 8 patients were diagnosed with complications in the early postoperative period (complication rate — 14.0%). In 2015, complications were identified in 10 people (complication rate was 22.7%). Thus, the tactics we used in the surgical phase of the complex treatment of colorectal cancer patients made it possible to reduce the incidence of early postoperative complications (anastomotic leakage). In group B, 6 (85.7%) patients who developed this complication required repeated surgery. In group A, only 4 (50%) patients required repeated surgical treatment, two of them required minimally invasive interventions.
CONCLUSIONS: The results of the following study show that optimisation of the perioperative management of patients, prevention of postoperative complications, individualisation of the treatment approach can reduce the length of hospital stay.
118-125
The applicability of cardiopulmonary exercise testing of young obese adults
Abstract
BACKGROUND: Obesity is an independent risk factor for cardiovascular disease. In this regard, the early detection of cardio-vascular disfunction among young adults is an important issue. This problem can be solved by the cardiopulmonary exercise testing.
AIM: The aim of this study is to determine the applicability of cardiopulmonary exercise testing to assess the functional cardiovascular state in young and obese adults.
MATERIALS AND METHODS: 84 young participants (18–44 years), 39% men, underwent a comprehensive examination including anthropometry, spirometry and cardiopulmonary exercise testing using a graded protocol in the period 2021–2022. Four groups of cardiopulmonary exercise testing indicators were assessed: metabolic, cardiovascular, ventilatory and pulmonary gas exchange parameters.
RESULTS: 35 participants (42%) were obese, 36 participants (43%) were smokers. The obesity had a negative impact on cardiovascular parameters of cardiopulmonary exercise testing: relative oxygen pulse on maximum load (60% vs. 72%, p = 0.004), heart rate on maximum load (86% vs. 90%, p = 0.024), maximum systolic blood pressure (181 mmHg vs. 156 mmHg, p < 0.001) and maximum diastolic blood pressure (92 mmHg vs. 83 mmHg, p = 0.040).
CONCLUSIONS: Cardiopulmonary exercise testing, especially assessing cardiovascular parameters, in young adults is in high practical interest for the functional cardiovascular status examination of individuals with obesity, smokers, and, particularly, in the case of their combination.
126-133
Case report
Surgical treatment of patients with ulcerative gastroduodenal bleeding: clinical cases
Abstract
The article presents two clinical cases of treatment of treating patients with ulcerative gastroduodenal bleeding from large chronic ulcers. In one case, the source of bleeding was a giant callous chronic gastric ulcer. The patient urgently underwent subtotal gastric resection with an inter-intestinal anastomosis according to the Roux procedure (18 hours after admission to the hospital), taking into account the high risk of recurrence of bleeding. In the second case, a patient with bleeding from a large chronic duodenal ulcer was operated on urgently (24 hours after admission to the hospital) in the following volumes: laparotomy, stitching of a duodenal ulcer, pyloroplasty according to Finney, subdiaphragmatic stem vagotomy. The purpose of the following clinical observation data is to demonstrate therapeutic tactics in relation to a group of patients with ulcerative gastroduodenal bleeding from large (more than 2.0 cm) chronic ulcers, high comorbidity and high risk of recurrence of bleeding.
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