RUDN Journal of Medicine

Relevance. To investigate the prognostic value of the Charlson Comorbidity Index (CCI) and its components in assessing outcomes related to in-hospital and 18‑month mortality and to determine additional prognostic value when incorporating them into the GRACE score among patients with acute myocardial infarction (MI). Material and methods. A prospective study enrolled 712 patients diagnosed with acute MI who underwent coronary angiography within 24 hours of hospitalization. Results and Discussion. Of the patients, 61 % were male, median age 65 (interquartile range [IQR] 56–74years). In-hospital and 18‑month mortality rates were 5.1 % (n     =     36) and 12.1 % (n     =     86), respectively. Median GRACE, CCI scores were 117 (IQR: 98–141), and 4 (IQR: 3–6) respectively. Common comorbidities within the CCI components included previous MI (21.8 %), diabetes mellitus (21.1 %), chronic pulmonary disease (16.2 %), dementia (9.2 %), peptic ulcer disease (9.1 %), renal failure (8.6 %). Factors associated with in-hospital and 18‑month mortality included chronic lung disease (odds ratio [OR]     =     4.21 and 2.04, respectively) and renal failure (OR     =     3.51 and 1.99, respectively) after adjusting for GRACE score. Dementia (OR 2.10; 95 % confidence interval [CI] 1.11–3.97) was a significant risk factor for 18‑month mortality. CCI was associated with in-hospital and 18‑month mortality (GRACE-adjusted OR 1.29, 95 % CI:1.07–1.57, p     =     0.001 and 1.37, 95 % CI (1.20–1.57, p     =     0.001, respectively). CCI demonstrated good predictive ability for in-hospital mortality (area under the ROC Curve [AUC]: 0.826) and modest performance for 18‑month mortality (AUC: 0.797). Adding chronic lung disease, renal failure in the GRACE score significantly improved the predictive efficacy for in-hospital mortality, with an AUC of 0.932 (95 % CI: 0.905–0.959, p =  0.001). Including CCI in the GRACE score enhanced the prediction efficiency for 18‑month mortality (AUC 0.819, 95 % CI: 0.768–0.871, p = 0.001). Conclusion. The CCI demonstrated moderate prognostic value in assessing in-hospital mortality among patients with acute MI and good predictive ability for long-term mortality. The CCI and its components (chronic lung disease, renal failure) added prognostic significance in addition to the GRACE score for predicting both short-term and long-term adverse outcomes.

Relevance. The leading position in mortality throughout the world is occupied by cardiovascular diseases, caused be atherosclerosis process. Statins used to be the gold standard of lipid-lowering therapy for a long time due to their high efficacy, optimal tolerance and safety. Nowadays it has been proved that statins reduce low-density lipoprotein levels in high doses by more than 50 %, in medium doses for about 30–49 %. However, often achieving the target level of lipoproteins is not possible due to a variety of reasons, what became a motivation for creating new drugs. The evidence base for the newest lipid-lowering drugs, some of which have already been approved for clinical use according to the publications in the scientific databases Scopus, PubMed, Web of Science for last 10 years. Main results of the most significant clinical trials of drugs’ effectiveness and safety are described including medicines: alirocumab, inclisiran, bococizumab, pelacarsen, mipomersen, bempedoic acid, lomitapide, evinocumab and also methods of therapeutic lipoprotein apheresis. Dyslipidemia pathogenetic points are considered like inhibition of proprotein convertase subtilisin-kexin type 9, suppression of genes synthesizing lipoprotein (a) by antisense oligonucleotides, cholesterol synthesis suppression by inactivation of adenosine triphosphate-citrate lyase enzyme; the action of microsomal inhibitors of triglyceride transfer protein. Conclusion. Searching for new lipid-lowering rational regimens is still ongoing, therefore it is necessary to carefully analyze effectiveness and safety profile for the newest drugs. Some of them like inhibition of proprotein convertase subtilisin-kexin type 9 are actively used in medicine today, while others, the most promising, will be in the future. Ensuring of atherogenic lipoproteins complete control will subsequently make a significant contribution to the primary and secondary cardiovascular diseases prevention, which will save many human lives.

Relevance. One of the most common complications after cardiac surgery is respiratory dysfunction (RD). The high-risk group includes patients after the left ventricle geometric reconstruction (LVGR) due to the presence of chronic heart failure, as well as the complexity and extent of the surgical intervention. At the moment, in clinical practice there is no uniform approach to predicting RD in patients in this group. The aim: to identify predictors of the development of RD in the early postoperative period in patients after LVGR. Materials and methods. The study included 54 patients who underwent LVGR surgery. Two groups of patients were identified: group I — patients without respiratory complications in the early postoperative period (n  =  34); group II — patients with RD in the early period (n  =  20). Cardiac function, respiratory system and gas exchange parameters were assessed in the pre- and early postoperative period. Results and Discussion. Echocardiography and spirometry indices in the group with RD were reduced before surgery relative to group I (FVC by 10.9 %, p  =  0.009; EDV by 27 %, p  =  0.004). Patients with RD on the first day after surgery were characterized by a pronounced disturbance in gas exchange compared to patients in group I (PaO₂/FiO₂ decreased by 45.1 %, p  <  0.001; Qs/Qt increased by 71.4 %, p  <  0.001). A multifactorial model was developed, which included three basic predictors of RD development: FVC, FEF₅₀ and EDV. With a decrease in model indicators by 1 %, the risk of developing RD increased by 33.5 %, 24.8 % and decreased by 6.5 %, respectively. According to ROC-analysis, the most significant indicators were FEV₃ (AUC 0.829 ± 0.079) and EDV (0.838 ± 0.087). To assess the risk of developing RD, a classification tree was constructed. Node 7 is characterized by the highest risk with the following parameters: FVC ≤ 89.5 %, EDV  >  173.2 ml, FEF₅₀ ≤ 78.9 %. Conclusion. Impaired gas exchange on the first day after surgery was detected in all studied patients, however, pronounced RD was observed precisely in patients with the most reduced parameters of the cardiorespiratory system before surgery. The developed model for predicting RD in patients after LVGR makes it possible to assess the risk of respiratory complications at the surgical planning stage and prepare the patient’s cardiorespiratory system for the upcoming surgical intervention.

Relevance. Healthcare today faces the inevitability of change as it faces a wide range of challenges in the face of complete uncertainty. Through effective change management, success can be achieved in states, globalization and complementarity. The scientific community recommends developing approaches to changes in management that focus on coordinated work in the field of healthcare of personnel, continuous training, exchange of experience, and professional development of medical personnel not only as specialists in the field of oncology, but also as successful managers. It is also necessary not to ignore social factors, namely the so-called “power of compassion”, which is expressed in the introduction and improvement of palliative care. The purpose of this article is to analyze the structure of management and organization of cancer care and proposals for improving the quality of treatment and care for cancer patients. This publication is devoted to a comprehensive analysis of the problems and prospects for the development of cancer care. Oncology is considered by us as one of the largest health problems. In this regard, ideas have been proposed on the need to modernize and optimize the processes of providing oncological care. According to the literature, important aspects in this process are the coordination of the actions of medical personnel, both doctors and nurses, and patients; their qualifications as oncology specialists and managers; provision and implementation of palliative care everywhere; quality control of provided medical services carried out directly by medical personnel. However, all of these components of the cancer care structure face the reality of a lack of actual time for medical personnel to train management skills, a lack of resources for regional health structures to implement palliative care and train staff in management skills. A positive aspect in this situation is the desire of the scientific community to improve itself and improve the skills of both oncologists and managers. Conclusion.The creation of specialized courses on management in the field of oncology and continuous international training through distance education and telemedicine is an important milestone in resolving these issues.

Relevance. The high primary incidence of peptic ulcer in people of working age and frequent relapses with a complicated course are accompanied by temporary but quite long-term loss of ability to work, a decrease in labor productivity and quality of life of patients, as well as disability and mortality, which determines the important medical, social and economic status of this disease. In addition, a significantly increasing contribution of primary morbidity to the overall morbidity is made by pediatric patients, and the morbidity of elderly and senile people is growing. In the Russian Federation in 2019, 1,188,551 cases of peptic ulcer disease were registered, 101,680 (8.5 %) of which were diagnosed for the first time in life. According to recent studies, the lifetime prevalence of peptic ulcer disease in the general population of the Russian Federation is 5–10 %, and the annual incidence is 0.1–0.3 %.In the Russian Federation, the incidence of ulcer in children in the last decade is 1100–1500 cases per 100,000 children. In 81–87 % of children, the localization of a newly detected ulcerative defect is determined in the duodenal zone, in 11–13 % — in the stomach wall, and in 4–6 % of children, a combination of ulcer localization in the stomach wall and duodenal zone is noted. The number of complications in the form of bleeding is recorded with an annual frequency of 19 to 57 per 100,000 people. (from 0.02 to 0.06 %). The number of complications in the form of perforation ranges from 4 to 14 cases per 100,000 people. (from 0.004 to 0.014 %). Mortality from complications of peptic ulcer and erosive and ulcerative lesions of the stomach and duodenum is 7.7 % of all deaths caused by diseases of the digestive system. Conclusion. Peptic ulcer disease currently remains one of the diseases of the human digestive system that requires studying the accumulated experience of domestic and foreign medicine and further multidisciplinary research to improve treatment results for this category of patients, and the epidemiology of gastric and duodenal ulcers continues to be of interest, both scientifically and from a practical point of view. 

Relevance. Traumatic brain injury (TBI) is a serious medical problem and one of the leading causes of disability and mortality among military personnel and civilians. It is known that about 1.5 million people in the world die from TBI every year, while about 2.5–3 million lose work capacity. In Russia, one million people are diagnosed with TBI every year, among which one in five gets group I or II disability. Despite significant efforts in research, effective TBI treatment methods are still limited, as TBI leads to a wide range of pathological changes in brain tissues. Primary brain damage is an acute and irreversible mechanical damage to the parenchyma of the nervous tissue. Among subsequent secondary processes are excitotoxicity, mitochondrial dysfunction, oxidative stress, axon degeneration, and neuroinflammation. These processes are often long and can take from several days to several years. Recent advances in cell therapy are opening up new perspectives for the treatment of this condition. The current review examines the main cellular mechanisms of TBI acute and chronic phases, as well as the treatment prospects for the use of stem cells for. Analysis of recent studies on the use of cell therapy in TBI is presented. Various types of stem cells such as neural stem cells, mesenchymal stromal cells and others are considered in the context of their potential to repair damaged brain tissues. Special attention is paid to the cells action mechanisms in the regeneration process, including their effect on inflammation, neurogenesis, and synaptic plasticity. The issue of using paracrine factors secreted by stem cells as a potential drug for traumatic brain injuries treatment is addressed. Conclusion. Сell therapy, as well as the use of products secreted by cells, is one of the new and promising ways of treating TBI.

Relevance. The work describes the results of neuropeptide compounds Semax and Selank in modulating disorders of the cellular link of immunity under experimental burn exposure. The aim — to study the effect of Semax and Selank on the number of white blood cells and phagocytic activity of neutrophils of white rats under experimental burn exposure. Materials and Methods. Burn injury in male rats of 6–8 months of age was modeled by expo animals; animals exposed to burns and not treated burn-exposed animals treated with Semax; animals exposed to burn and treated with Selank. Neuropeptide injections at 100 μg/kg/day were performed intraperitoneally daily for 14 days from thermal burn simulation. To study the immunity parameters, the number of white blood cells and the percentage of lymphocytes, rod and segmented neutrophils were calculated, and the phagocytic activity of neutrophils was assessed. Results and Discussion. It was established that under the conditions of experimental burn exposure, there is an increase in the parameters of the cellular link of immunity: phagocytic activity of neutrophils, phagocytic index, phagocytic number, leukocytic coefficient and number of leukocytes. The activation of granulocyte formation was evidenced by an increase in the rod-nucleating forms of leukocytes (shift of the leukocyte formula to the left). Intraperitoneal injections of the neuropeptide drugs Semax and Selank against the background of thermal skin injury contributed to the correction of the observed changes in white blood parameters and functional neutrophil activity. Conclusion. Thus, under the conditions of a skin burn wound with the use of neuropeptide compounds Semax and Selank, dysfunctional transformations of immunocompetent cells are restored, which confirms the complex effect of Semax and Selank on systemic disorders against the background of local stress, namely, the manifestation.

Relevance. The problem of diagnosing hereditary neuromuscular diseases is one of the most difficult in the medical specialists’ practice. Molecular genetic diagnostics is one of the fundamental aspects in the classification and subsequent approaches to the treatment and prevention of hereditary diseases. Pathogenic variants identification leads to the formation of separate subtypes and phenotypically identical diseases syndromes. This review examines modern diagnostic methods and algorithmization of patients with neuromuscular diseases. Despite enormous research and clinical efforts, the molecular causes remain unknown for almost half of patients with neuromuscular diseases due to genetic heterogeneity and molecular diagnostics based on a gene-by-gene approach. Next-generation sequencing (NGS) is an effective and cost-effective strategy for accelerating patient diagnosis. However, the diagnostic value of conducting and prescribing whole- exome or whole- genome sequencing is largely dependent on the clinical picture of the disease and the professional competence of the doctor. Hereditary neuromuscular diseases have similar initial symptoms, and molecular genetic diagnostics can pinpoint the cause and pathogenesis of the observed disorders in the patient. Conclusion . The molecular diagnostics algorithm is based on sequential analysis, starting with the search for the most common pathogenic variants using inexpensive and rapid methods, and progressing to the search for rare, previously undescribed pathogenic variants using whole-g enome/whole-exome studies. The phasing allows science and medicine to uncover previously unknown causes of severe disease in patients with neuromuscular diseases, which often leading to disability or premature death. Earlier genetic diagnosis should provide more effective treatment of the disease and better genetic counseling for families and will also allow access to pathogenetic therapy for neuromuscular diseases.