Cardiotoxicity of anthracycline chemotherapy drugs is one of the main interdisciplinary problems in the research area of cardio-oncology. As is known, the high antitumor efficacy of anthracycline antibiotics is significantly leveled by the development of disabling and lethal heart lesions. However, the pathogenesis of toxic heart disease, as well as diagnostic criteria and markers of anthracycline-induced cardiomyopathy are not fully understood. The article provides a detailed review of potential markers of anthracycline cardiotoxicity from the position of disease pathogenesis. The scheme of pathogenetic development of anthracycline-induced cardiomyopathy is proposed in this article. The main methods of diagnostics of toxic damage of the heart that are currently used in clinical researches of domestic and foreign scientists are reviewed.

Objective. This review article provides an analysis of studies focusing on the problem of comorbid tension-type headache (TTH) and hypertension (HT).

Key Points. A combination of headache and HT is common in clinical practice. The analysis of studies showed that 53.7% of hypertensive patients present with complaints of headache, and 30.7% of headache patients have HT in the anamnesis. The prevalence of HT is 1.9 times higher in TTH patients than in those with migraine. The results demonstrate the presence of two separate, but highly comorbid nosologies (HT and TTH) among study participants included in the review. Evaluation of research methodology showed that the discrepancies in the results may be explained by the differences in design and sample characteristics (degree and profi le of HT; duration of HT and TTH). Patients with mild HT do not have direct associations between headache and increased blood pressure. Blood pressure values do not diff er during, before, and after TTH paroxysm. HT is less prevalent in patients with episodic TTH compared with that in patients with chronic TTH.

Conclusion. The analysis of available studies suggests that TTH + HT phenotype is a frequent condition, but its real prevalence rates require further studies.

The problem of association between obstructive sleep apnea syndrome (OSAS) and cardiac pathology, namely, atrial fibrillation (AF) is quite relevant and multifaceted. This review presents the epidemiological aspects of OSAS and AF, discusses the main concepts of atrial arrhythmogenesis in OSAS, and describes the capabilities of diagnostic tools for searching for OSAS in the context of routine cardiological practice.

Delirium is a predictor of poor outcome in both myocardial infarction and other nosologies. Despite the growing interest in this problem, no effective methods for prediction, prevention, and treatment of delirium have been found. This literature review highlights the current ideas about delirium etiology, pathogenesis, approaches to prevention and treatment, and features of delirium in patients with myocardial infarction. The review presents the analysis of clinical trials and meta-analyses with the identification of causes for clinical trials failures and the search for future promising directions of research focusing on this syndrome.

Myocardial fibrosis is a multifactorial process, which predisposes to a number of cellular and molecular factors, the level of which is determined genetically. This review discusses some genetic variants that are directly related to the development of cardiac fibrosis and open up prospects for scientific research on assessing the risk of heart failure in various cardiovascular pathologies.

Primary cardiomyopathies in childhood are a rare but serious disease that is a common cause of heart failure and the most common reason for heart transplantation in children over one year of age. Over the past decades, the diagnosis of cardiomyopathy has advanced from traditional clinical imaging methods to new genetic and imaging techniques. The article presents a review of the literature data on the modern classification of primary pediatric cardiomyopathies and the features of the clinical course and imaging, which is an integral part of the diagnosis based on the primary morphofunctional phenotype.

Purpose. To determine the incidence of type 2 myocardial infarction (MI) diagnosis (according to the Fourth Universal Definition) and the features of patient management in real clinical practice.

Material and Methods. A retrospective study was performed by analyzing the case histories of 153 patients diagnosed with acute coronary syndrome (ACS). Inclusion criteria were the presence of ACS at admission followed by a confirmed diagnosis of MI during the hospital period according to the Fourth Universal Definition of MI and the age of patients > 18 years. Patients with severe comorbidities affecting the immediate prognosis and/or being an alternative to the diagnosis of MI were not included in the study.

Results. The study showed that emergency coronary angiography was performed in 151 patients (98.7%). A decrease in the renal filtration function in the presence of chronic kidney disease was a contraindication to this study found in 1.3% of cases; 12 (8%) patients did not have coronary artery disease or had stenoses of less than 50%; these patients comprised the group of patients with type 2 MI. While analyzing the results of examination in patients with type 2 MI, ST segment elevation was detected in seven patients (58.4%) according to electrocardiography; ST segment depression was observed in one patient (8.3%); complete left bundle-branch block was found also in 1 case (8.3%), three individuals (25%) did not have any changes in the position of ST segment, but had a negative T wave. Analysis of possible etiological factors in the development of type 2 MI showed the presence of sinus tachycardia in two patients (16.7%), severe sinus bradycardia in one patient (8.3%), fl utter paroxysm and atrial fibrillation with tachysystole throughout the ventricles in two patients (16.7%), and history of atrial fibrillation in one patient (8.3%).

Conclusion. Type 2 MI was diagnosed in 8% of patients with ACS with and without ST segment elevation where cardiac arrhythmias including sinus arrhythmias may be the potential etiological factors. Limited capabilities of assessing the stability of atherosclerotic plaque in the coronary artery including that in the presence of plaque thrombosis represent a significant negative factor for establishing diagnosis in routine clinical practice.

The tuberculosis (TB) dispensary patients are often diagnosed with cardiac diseases, but the regulatory documents associated with TB care refer to the procedures and standards of examination and treatment of TB patients or patients with suspected TB while the management of associated chronic diseases is carried out in other medical institutions. There is lack of continuity between doctors of different specialties. Patients face organizational problems of accessibility and quality of medical care. The creation of Department of Medical and Social Care and Rehabilitation in TB dispensary with therapeutic profile specialists became especially urgent in the period of coronavirus pandemic.

Aim. The aim of the study was to estimate the expediency and effectiveness of Department of Medical and Social Care and Rehabilitation in detection and treatment of comorbid cardiac pathology in patients of TB dispensary during coronavirus (COVID-19) pandemic.

Material and Methods. All patients of the St. Petersburg TB dispensary No. 5 were examined according to specially developed algorithm to detect and treat the cardiac pathology comorbid with TB. Results. Cardiac diseases comorbid with tuberculosis were detected using an integrated multidisciplinary approach to examination of TB patients during the pandemic of coronavirus infection. Examination, consultation, and necessary treatment were carried out directly in TB dispensary allowing to avoid disease exacerbations and complications during the entire period of monitoring.

Conclusion. The establishment of Department of Medical and Social Care and Rehabilitation in TB dispensary No. 5 showed the relevance and timeliness of this measure. The coronavirus genesis of some cardiac diseases required to revise the management tactics of affected tuberculosis patients.

The prevalence of thyroid diseases including autoimmune hyperthyroidism (Graves’ disease), autoimmune thyroiditis, and different forms of thyroid cancer is increasing every year, while the effectiveness of their treatment remains low and is limited, mainly, to replacement therapy with thyroid hormones and surgical and radioisotope methods. This review presents the current state of the problem of pharmacological correction in thyroid diseases including new approaches to the regulation of the functional activity of the components of the thyroid hormone synthesis system in thyroid follicular cells, in particular, its initial, sensory component, the thyroid-stimulating hormone receptor. Among the drugs that are currently being developed, it is necessary to focus on allosteric regulators of the thyroid-stimulating hormone receptor, specific antibodies to it, as well as selective agonists of the β-isoform of thyroid hormone receptors.

Introduction. Patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (T2DM) are characterized by sympathetic hyperactivity. A promising method for the assessment is a measurement of erythrocyte membrane beta-adrenergic reactivity (β-ARM). However, little is known about β-ARM in patients with RHTN and T2DM.
Purpose. To investigate the properties of β-ARM of erythrocytes in patients with RHTN and T2DM in relation to clinical, laboratory, and instrumental data.
Material and Methods. The cross-sectional study comprised 38 patients with RHTN combined with T2DM with mean age of 62.1 ± 7 years (25 women (65.8%)), 24-hour systolic/diastolic blood pressure (24-BP) (SBP/DBP) of 160.3 ± 14.2/90.8 ± 10.5 mm Hg, and glycated hemoglobin (HbA1c) of 7.2 ± 1.4%. The comparison group comprised 24 patients with RHTN without T2DM, which did not significantly differ in sex and age. General clinical examinations, measurements 24-BP and office blood pressure, β-ARM, HbA1c, 24-hour urine, echocardiography, and 24-hour electrocardiography with the assessment of heart rate variability (HRV) with low-frequency (LF) and high-frequency (HF) components were performed in all patients.
Research Results. In both groups, β-ARM was significantly higher than the normal value corresponding to 20 conventional units (CU): 45.9 ± 21.9 and 41.3 ± 18.9 for patients with RHTN+T2DM and RHTN without T2DM, respectively, p = 0.39. The incidence of increase in β-ARM was comparable: 82% in RHTN with T2DM patients and 88% in RHTN without T2DM patients, χ2 = 0.38, p = 0.537. The β-ARM values correlated with duration of hypertension (R = 0.31), SBP-24 variability (R = 0.36), LF (R = 0.60), and HF (R = –0.53)) values according to HRV, 24-hour urine volume (R = –0.32), left ventricular parameters (ejection fraction (R = 0.42), ventricular efficiency (R = –0.36), arterioventricular coupling (R = –0.40)), duration of T2DM (R = –0.45), and HbA1c level (R = –0.55).
Conclusions. RHTN patients were characterized by a high frequency of β-ARM increase, whether or not T2DM was present, although a long and severe course of T2DM was associated with lower values of this indicator. According to the data from instrumental studies, β-ARM in patients with RHTN and T2DM was quantitatively related to the markers of sympathetic activity, which correlated with the duration of hypertension and parameters of renal and left ventricular functional status.

Introduction. According to recent data, thoracic aortic surgery have reduced morbidity and mortality, however, women are at increased postoperative risk of adverse outcomes. Our aim was to evaluate and compare early outcomes in male and female patients undergoing ascending aortic replacement.
Methods. A total of 88 patients, consisting of 54 men (61.4%) and 34 women (38.6%) underwent ascending aortic surgery for non-syndromic aneurysms from January 2013 to December 2021. We analyzed clinical outcomes between males and females.
Results. According to computed tomographic angiography, preoperative normalized aortic diameters were significantly larger in females (2.9 [2.7; 3.2] cm/m2) vs. (2.5 [2.3; 2.6] cm/m2, p < 0.001) in males, without differences in absolute values (51 [49; 53] mm vs. 52 [50; 53] mm, p = 0.356). There were no significant differences in neurological, cardiac, pulmonary, and renal complications in both groups in the early postoperative period. In-hospital mortality was 1.9% and 5.9% (p = 0.307) in male and female patients, respectively.
Conclusions. Ascending aortic surgery for aneurysms below 5.5 cm threshold has tolerable early outcomes both in men and women.

Purpose. The aim of the study was to investigate the subpopulation composition and prooxidant activity of adipose tissue cells in the big omentum of patients with metabolic syndrome.
Material and Methods. A fragment of white adipose tissue obtained from the greater omentum during planned endoscopic cholecystectomy in 37 female patients aged 48 (34; 65) years was used as a material for the study. The main group was represented by patients with metabolic syndrome (n = 31) diagnosed according to current recommendations for management of patients with metabolic syndrome. Six patients without signs of metabolic syndrome, comparable with the main group in terms of age and gender, made up the comparison group. The subpopulation composition of the adipose tissue cells in the greater omentum was determined by immunohistochemical analysis. The content of reactive oxygen species in the isolated cell pools of adipocytes and mesenchymal stromal cells was identified using flow cytometry.
Results. Comparison of the mean values in the groups showed a statistically significant prevalence in patients with metabolic syndrome only in the level of cells expressing CD68 (macrophage marker) on their surface (p < 0.05). Correlation analysis allowed to detect a positive relationship between morphometric indicators determining the severity of infiltrative changes of adipose tissue (the number of infiltrates) and the relative number of cells presenting CD3 (r = 0.357, p < 0.05), CD36 (r = 0.575, p < 0.05), and CD68 (r = 0.374, p < 0.05) on their surface, respectively. A comparative analysis of the level of reactive oxygen species in adipose tissue cells showed statistically significantly (p < 0.05) higher values of reactive oxygen species in patients with metabolic syndrome compared with the control group both in adipocytes and in mesenchymal stromal cells.
Conclusion. The presence of a positive correlation between the relative numbers of cells presenting CD3, CD36, and CD68 markers and the morphometric parameters reflecting the severity of infiltrative manifestations suggested that the mentioned cell lymphocyte and macrophage populations were involved in the development of infiltration in the adipose tissue in metabolic syndrome. The pro-inflammatory phenotype of adipose tissue in metabolic syndrome was characterized not only by a number of morphological features, but also by enhanced prooxidant activity of the adipocytes and mesenchymal stromal cells.

Background. Atherosclerosis is one of the leading cardiovascular pathologies. Evidence suggests that DNA damage caused by endothelial cell exposure to mitomycin C (MMC) leads to endothelial dysfunction and is the risk factor for this disease. MMC is an alkylating mutagen involved in the development of oxidative stress, which is also a risk factor for atherosclerosis. Aim. To access the levels of oxidative stress markers in the primary human endothelial cell culture exposed to alkylating mutagen MMC.

Material and Methods. Commercially available primary cultures of endothelial cells obtained from human coronary artery (HCAEC) and human internal thoracic artery (HITAEC) were used in the study. The cells were cultivated in the presence of 500 ng/mL MMC (experimental group) and without mutagenic load (control group). The levels of reactive oxygen species, reactive nitrogen species, and 8-OH-deoxyguanosine (8-OHdG) in cell growth media were assessed by enzyme-linked immunosorbent assay. The relative telomere length and expression of TERT and POT1 genes were accessed in endothelial cells by quantitative polymerase chain reaction. Statistical analysis of data was performed using GraphPad Prism 9 software.

Results. There were no differences in the concentrations of reactive oxygen species, reactive nitrogen species (NO2 -, NO3 -, NO2 -/NO3 -), and 8-OHdG in HCAEC and HITAEC cultures exposed to MMC compared to the corresponding parameters in the non-exposed controls. At the same time, HCAEC and HITAEC exposed to MMC were characterized by a decrease in the relative telomere length compared to control (10.97 vs. 27.03 in HCAEC, p = 0.002 and 9.12 vs. 25.64 in HITAEC, p = 0.001). Moreover, we discovered 1.75-fold increase in the expression of POT1 gene in the experimental HCAEC compared to control (p = 0.019). No expression of TERT gene was observed in study groups.

Conclusions. Alkylating mutagen MMC did not induce any pronounced oxidative stress in the primary human endothelial cells in vitro. The development of endothelial dysfunction caused by MMC exposure was triggered mainly by DNA alkylation resulting in the genotoxic stress in the endothelial cells.

Objective. The aim of the study was to evaluate the effect of medicinal plant extracts on insulin sensitivity in the model of diabetes mellitus.
Material and Methods. Experiments were carried out using 110 outbred white male rats. Diabetes mellitus was induced by the administration of streptozotocin to animals receiving food with a high fat content for the formation of insulin resistance. The animals were injected with metformin, rosiglitazone, and aqueous extracts of nettle, dandelion, burdock, and Galega officinalis. The rats were divided into two groups during pharmacotherapy: group 1 continued to receive fat-enriched diet; group 2 received a regular diet with 8% fat content. The blood levels of glucose, glycated hemoglobin, triglycerides, and high-density lipoprotein cholesterol were measured. The metabolic index was calculated to assess insulin resistance.
Results. The extracts of nettle and burdock reduced the concentration of glucose and glycated hemoglobin in animals with a model of diabetes mellitus treated with fat-enriched food. Dandelion extract did not change the level of fasting glucose in blood whereas it lowered the concentration of glycohemoglobin. The extracts of nettle, Galega officinalis, and dandelion reduced blood concentrations of glucose in animals receiving normal diet. The extracts of all plants reduced the level of glycated hemoglobin. The concentration of triglycerides normalized regardless of the diet when plant extracts were introduced. The concentrations of high-density lipoprotein cholesterol increased in both diets in animals treated with Galega officinalis and dandelion extracts. The metabolic index in rats receiving food with 8%-fat content did not differ from that of intact animals after therapy with nettle and Galega officinalis extracts. Dandelion extract alleviated insulin resistance in animals continuing to receive a diet enriched with fats.
Conclusion. The extracts of nettle, Galega officinalis, burdock, and dandelion improved carbohydrate and lipid metabolism in diabetes mellitus caused by the administration of streptozotocin to rats to the same extent as metformin and rosiglitazone. Extracts of nettle and Galega officinalis alleviated insulin resistance in animals receiving a normal diet; dandelion extract alleviated insulin resistance in animals receiving fat-enriched food.

The article presents a clinical example of using the diagnostic algorithm for identifying the criteria for atrial cardiopathy in a patient with cryptogenic stroke. This clinical case required prolonged ECG monitoring, detection of subclinical atrial fibrillation, and subsequent collegial establishment of indications for initiation of anticoagulant therapy taking into account the high risk of recurrent stroke.

We present a clinical case of acute hepatitis confirmed by liver biopsy. A 24-year-old patient underwent pulse therapy with methylprednisolone due to the onset of multiple sclerosis. The liver enzyme values were within the normal range 15 days later. Blood tests revealed the development of cytolysis syndrome during an unrelated medical examination two months later. Obvious causes of hepatitis were excluded, and liver biopsy was performed to verify the diagnosis. The biopsy showed a picture of acute hepatitis with high histological activity and development of submassive necrosis. The situation was interpreted as drug-induced liver injury after pulse therapy with methylprednisolone. Oral prednisone therapy was prescribed, and the inflammation and liver injury were reverted. The presented clinical case highlights the importance of follow-up of patients receiving high doses of methylprednisolone.

Gout belongs to the group of microcrystalline arthritides and is a systemic tophus manifested by inflammation of various tissues caused by deposition of monosodium urate crystals. Verification of gout diagnosis in Russia takes on average four to eight years from the beginning of the disease. This period is sufficient for the development of various complications (for example, gouty nephropathy) and disability of patient, and, therefore, it is necessary to revise the existing strategy for the diagnosis of this disease. One of the options for improving the provision of medical care can be attributed to the creation of a clinical decision support system (CDSS), which is based on the knowledge of experts, formalized as a knowledge base (KB).

Aim. To develop a KB structure for CDSS for gout diagnosis.

Material and Methods. Clinical information for gout diagnosis, presented as a nomenclature of medical concepts and logical schemes, which were collected on the basis of federal clinical recommendations, various literature sources and expert knowledge were used as materials. The ontological method was used as a method of knowledge structuring. Combined semantic network and frames were used as the methods of representation.

Results. While developing KB structure, a combination of two methods of knowledge representation including semantic network and frames was used. An ontological approach was used in terms of knowledge structuring. The structure was built on the clinical knowledge collected in cooperation with experts in gout diagnosis. Compared with similar developments of diagnosing diseases based on knowledge engineering methods, the main feature of developed KB structure was the use of a separate type “Syndrome” concept as an aggregator accepted in medicine, significantly reducing the volume of KB for diseases.

Conclusion. The KB structure was developed comprising the use of seven types of concepts and 11 types of relationships. The structure involved the use of ontological approach and combination of two models of knowledge representation, namely: a semantic network and a frame model.

Equipment management is an integral part of the health care delivery cycle. The absence or poor functioning of modern, safe, and effective medical devices and equipment reduces the volume and quality of medical services.

Aim. The purpose of this study was to analyze existing approaches to medical equipment management in the practice of domestic and foreign health care. The content analysis was used as the methodological tool aimed at performing the analysis of foreign and domestic full-text sources in the PubMed/MEDLINE and eLIBRARY databases from 2002 to 2022. The authors of this study presented generalized principles, advantages, and disadvantages of equipment management as well as the experience of different countries in equipment management.

Conclusions. 1) The problems of procurement, modernization, and maintenance of equipment in health care are as relevant as in other areas of activity. 2) There is currently a lack of a clear view of managers regarding the construction of resource management. 3) There is a lack of applied research in the domestic literature in the analysis of modern approaches to medical equipment management.