Vol 27, No 12 (2025): Comorbidity in internal medicine

Background. With the increasing prevalence of metabolic-associated fatty liver disease (MAFLD) among patients with metabolic syndrome, there is a growing incidence of neurocognitive decline, depression, and anxiety. Similar complaints are observed in post-COVID syndrome. This spectrum of disorders poses a significant socio-economic burden, substantially impacting quality of life and work capacity.

Aim. To assess the quality of life, psycho-emotional, and cognitive status of patients with MAFLD who recovered from COVID-19-associated pneumonia (COVID-AP).

Materials and methods. In a cross-sectional study utilizing telephone surveys, patients hospitalized for COVID-AP between December 2021 and January 2022 were evaluated for the need for subsequent hospitalization and any medical consultations after discharge; work capacity; memory impairments; stress levels; and quality of life using validated assessment scales.

Results. A total of 71 patients were included in the final analysis: 17 patients with confirmed MAFLD and 54 controls. The groups were comparable by sex (p=0.55) and age (p=0.935). The MAFLD group demonstrated a higher frequency of impaired glucose tolerance (p<0.001) and a need for medication and/or dietary interventions to control blood sugar following COVID-AP (odds ratio – OR 6.22; p=0.015). Patients with MAFLD showed reduced quality of life due to difficulties in daily activities (OR 17.967; p<0.001), increased levels of anxiety and depression (OR 3.491; p=0.031), decreased health satisfaction (p=0.014); issues related to forgetfulness and memory (p=0.036), and short-term memory (p=0.013). MAFLD patients more frequently reported doubts about their ability to cope with personal problems (p=0.004) and dissatisfaction with their work capacity (p<0.001).

Conclusion. MAFLD significantly impairs quality of life, increases the risk of psychological stress and depression, worsens memory and cognitive functions, and reduces work capacity. Integrated clinical approaches addressing both metabolic and post-COVID complications are necessary to improve overall patient outcomes.

The article describes a clinical case of granulomatous interstitial nephritis (GIN) in a 26-year-old woman with an ulcerative colitis (UC). The initial manifestation of inflammatory bowel disease (IBD) in the patient was severe abdominal bloating and pain appeared in 2018 on the background of stress. The clinical presentation was nonspecific, and irritable bowel syndrome was diagnosed. Probiotics were prescribed with minimal positive effect. Since January 2019, the patient has had frequent loose stools with mucus and streaks of blood and the diagnosis of irritable bowel syndrome have been changed to IBD. In March 2019, according to a colonoscopy with biopsy, a diagnosis of UC was established. Subsequently, it was repeatedly confirmed by colonoscopy and histological data. Treatment with 5-aminosalicylic acid (5-ASA) preparations has been prescribed. For the first time in January 2020, a slight increase in creatinine level was noticed. In August 2021, against the background of a recurrent course of UC, an increase in creatinine level by more than two times and a significant decrease in glomerular filtration rate were detected. Tubulointerstitial nephritis was diagnosed. Subsequently, a biopsy revealed a large interstitial granuloma consisting of epithelioid cells with an admixture of eosinophils and neutrophils. The diagnosis was clarified as GIN. The disease developed against the background of IBD–UC, which is atypical and necessitates ruling out other causes. During an exacerbation of UC, the patient was also diagnosed with high titers of Epstein–Barr virus. In this regard, EBV infection, as well as preparations of 5-ASA, can also be considered among the probable causes of the development of GIN. As treatment, the patient received three courses of intravenous pulse therapy with methylprednisolone, with a total dose of 9000 mg. The treatment proved effective, leading to a decrease in creatinine levels and proteinuria. Notably, the baseline therapy for UC with 5-ASA drugs was not discontinued during this period.

Slow growth and growth retardation compared to age norms are a common reason for seeking specialized medical care from a pediatrician and pediatric endocrinologist. Anthropometric monitoring, including dynamic assessment of height and weight parameters, is the most important component of clinical examination in pediatrics, since it serves as an integral marker of somatic health and physical development of the child. The etiology of short stature is characterized by significant polymorphism, which necessitates a two-stage diagnostic algorithm: verification of the growth retardation itself and subsequent determination of its pathogenetic mechanisms. This condition can manifest itself in a wide range of pathological conditions, including somatotropic insufficiency. The list of nosologies associated with short stature includes: chromosomal abnormalities and genetic syndromes (Turner, Prader–Willi, Silver– Russell – SRS, Noonan syndromes), skeletal dysplasia of various origins; congenital and acquired metabolic disorders, intrauterine growth retardation, chronic somatic diseases; idiopathic forms (familial and non-familial variants), endocrine disorders. The presented review examines SRS from the perspective of a modern view of the problem of pathogenetic mechanisms, variants of clinical manifestations, as well as methods of diagnostic research and therapy. SRS is a rather rare genetic disease, the main manifestations of which are prenatal developmental delay, expressed in a deficiency of the newborn's body weight and length relative to gestational age, as well as postnatal hypotrophy, accompanied by various congenital anomalies caused by disorders of embryogenesis. Typical clinical signs of this syndrome include: relative macrocephaly at birth, triangular facial contour, disproportionate body type, clinodactyly, and the presence of areas of skin hyperpigmentation. Birth weight in children with SRS does not exceed 2500 g, height is less than 45 cm. One third of children with the syndrome are born prematurely, while the anthropometric indicators also do not correspond to the gestational age, which indicates a primordial nanism. Children have a decreased appetite and slow weight gain. The prognosis for SRS is generally favorable if the disease is diagnosed in time and adequate therapy is carried out. Most patients successfully adapt to society and develop intellectually within normal limits, despite short stature and specific appearance features.

Background. It is known that the gut microbial community has a significant impact on the health of the host organism. It has been shown that changes in the composition and metabolic potential of the microbiota occur in people with obesity and diabetes type 2 (T2D). However, the impact of the microbiota on metabolic changes after bariatric surgery remains unclear.

Aim. To assess the influence of the gut microbiome composition on metabolic parameters in patients with obesity and T2D after bariatric surgery.

Materials and methods. The study included patients with T2D and obesity, who were treated with bariatric surgery (gastric bypass). Before surgery, as well as 6 and 12 months after surgery, the anthropometric, laboratory parameters were measured, feces were collected for analysis of the intestinal microbiota. The microbiota composition was determined through sequencing of the 16S rRNA gene from stool samples. For a subset of patients, the stool metabolome was also studied.

Results. After surgery, there was a significant positive trend in weight loss, glycemia, lipid spectrum parameters, and insulin resistance. However, patients did not achieve target levels of 25(OH) vitamin D and calcium. Taxa were identified whose abundance before surgery was associated with the dynamics of parathyroid hormone and vitamin D. The order Verrucomicrobiales was negatively associated with vitamin D dynamics, while the order Fusobacteriales, which includes hydrogen sulfide producers in the gut, was positively associated with the increase in parathyroid hormone. Interestingly, these bacteria were also elevated in patients with higher total cholesterol levels prior to intervention, whereas other H₂S producers in the gut correlated with C-peptide levels. No significant associations between the metabolome and clinical parameters' were found; however, the correlation structure of microbiome and metabolome data in patients with obesity was examined.

Conclusion. The study revealed an association between several intestinal microbiota species and metabolic parameters after bariatric interventions. These results are pilot and, if reproduced, may allow the prediction of the bariatric surgery effects on weight and glycemia based on the composition of the gut microbiota.

Macrophages are a heterogeneous population of immune cells derived primarily from bone marrow monocytes and embryonic yolk sac erythromyeloid progenitors, capable of altering their phenotype and functions depending on the microenvironment. This article presents a review of current knowledge on the origin, structure, and function of dermal macrophages, including historical data from the first observations by I.A.E. Goeze (1777), confirmed by W.F. von Gleichen-Russwurm, the term "Fresszellen" by K. Klaus, and the phagocytic theory of I.I. Mechnikov (1882–1884) to the M1/M2 dichotomy of Mills et al. (early 2000s). This paper summarizes literature data on the human monocyte-macrophage system in both normal and pathological conditions, taking into account the heterogeneity of classical monocytes as precursors of tissue macrophages, non-classical monocytes for endothelial homeostasis, intermediate and organ-specific macrophages (Langerhans cells in the epidermis, microglia in the central nervous system, and Kupffer cells in the liver). Data are presented on various macrophage phenotypes, from proinflammatory M1 with glycolytic metabolism and inducible nitric oxide synthase to reparative M2 with mitochondrial respiration and arginase-1, and their involvement in immune surveillance, skin protection, regeneration, angiogenesis, and tissue remodeling. The article presents an analysis of the role of macrophages in response to cosmetic procedures: ablative and non-ablative lasers 10600 and 1550 nm, microneedle RF, SMAS-lifting, injections of polylactic acid, calcium hydroxyapatite, the role of Langerhans cells in response to external stimuli of ultraviolet radiation, cosmetics, etc., the role of macrophages in the development of fibrosis M₁-initiation, M_2a-proliferation, M_2c-resolution, SPP1+ with CXCL4 from platelets, PRP-hypothesis, regulation of the adipocyte population in dermal-associated adipose tissue dWAT, elimination of biomaterials. Attention is paid to resident dermal macrophages located perivascularly and perineurally in the papillary and reticular layers, their ability to proliferate in situ to maintain homeostasis, the synthesis of collagenase enzymes, elastase, hyaluronidase and cytokines that regulate the functions of dermal and epidermal cells.

The incidence of HIV infection continues to rise over the past several decades, causing serious concern among healthcare professionals. Human Immunodeficiency Virus (HIV) destroys the immune system, significantly reducing its protective functions and increasing the body's vulnerability to the development of oncological diseases. According to various authors, HIV-associated neoplasms tend to be more aggressive, and in most cases, the diagnosis is made at advanced stages, when the neoplasm has often spread to organs and systems distant from the primary site. A significant factor in this is the prolonged diagnosis of oncological diseases in HIV-infected patients, which is related to the complexity of interpreting research data and the similarity of the clinical picture of oncological processes with a range of other diseases and conditions associated with HIV. The reduction in CD4+ cell counts, the ineffectiveness of CD8+ cell responses, and the resulting immune dysregulation lead to a weakening of local immune surveillance. The functional activity of CD4+ cells is also crucial, as it influences tumor antigen recognition, the production of effective anti-tumor antibodies, and the response to oncogenic viral invasion – another pathogenetic factor contributing to the development of oncological diseases in the context of HIV. Likely, this contributes to early tumor dissemination even at initial disease stages, with pronounced involvement of extralymphatic organs and systems, due to the absence of barriers to hematogenous metastasis. Such early dissemination serves as additional evidence of significant impairments in anti-tumor immune control in HIV-infected individuals at all stages of malignant neoplasm development. Therefore, it is critically important for at-risk groups to maintain vigilance, undergo regular medical examinations, and promptly identify potential complications. This study presents a clinical case of a 30-year-old patient who developed non-Hodgkin's lymphoma and disseminated lung syndrome against the background of HIV infection. These data help to better understand the challenges of diagnosing and treating this combination of diseases and provide valuable information for improving medical care for patients with HIV.

Background. Peripheral venous catheterization (PVC) is one of the most frequently performed invasive procedures in hospital practice. It is widely used for administration of infusion solutions, medications, and blood products. Despite its relative simplicity and perceived safety, PVC is often accompanied by local complications that may worsen clinical outcomes and patient discomfort. Identification of clinical risk factors for complicated PVC remains an important task for improving the quality of vascular access and optimizing patient management strategies.

Aim. To identify statistically significant clinical predictors of complicated peripheral venous catheterization and to assess their impact on the development of catheter-related complications.

Materials and methods. The study included 167 cases of PVC performed in surgical and rehabilitation departments. Demographic and clinical characteristics were analyzed, including patient age, body mass index, history of previous PVC-related complications, vein visualization and palpation prior to puncture, catheter gauge, duration of catheter placement, and features of the catheterization technique. The frequency and structure of local complications were evaluated. Univariate logistic regression analysis was used with calculation of odds ratios (OR) and 95% confidence intervals.

Results. Complications were identified in 66.5% of cases. The most common were pain at the catheter insertion site (25.2%), phlebitis (15.3%), extravasation (12.6%), hematoma (10.2%), and catheter obstruction (8.4%). Significant risk factors for complicated PVC included a history of complications (OR=15.6), small vein diameter (OR=5.38), absence of vein visualization or palpation prior to puncture (OR=3.40), catheter dwell time exceeding 48 hours (OR=3.12), BMI>28 (OR=4.00), and age over 18 years (OR=3.53).

Conclusion. Several clinical parameters were identified as significant predictors of complications associated with PVC. Consideration of these factors enables early risk stratification, supports justified selection of vascular access techniques, and allows for individualized patient management. Implementation of a risk-based approach to PVC may contribute to reducing complication rates, improving procedural safety, and enhancing the overall quality of medical care.

Background. Thrombotic conditions and complicationsa are among the leading causes of death and disability in high-income countries. The introduction of direct oral anticoagulants into clinical practice has expanded the possibilities of anticoagulant therapy. Having a broader spectrum of indications compared to other direct oral anticoagulants, rivaroxaban is also used to prevent atherothrombotic complications in patients with ischemic heart disease and peripheral artery disease. Rivaroxaban drugs are available as film-coated tablets in doses of 2.5 mg, 10 mg, 15 mg, and 20 mg. Currently, more than 45 generic versions of rivaroxaban are approved in Russia, which may differ in the source and particle size of the active pharmaceutical ingredient, as well as the excipient composition.

Aim. To assess the in vitro equivalence of brand-name vs. several generics of rivaroxaban that are available on the Russian market using the equivalence dissolution test.

Materials and methods. The study was performed on rivaroxaban film-coated tablets (2.5, 10, 15, and 20 mg): Xarelto® (Bayer AG, Germany) as the reference drug (D 0), and three randomly selected generic drugs (D 1, D 2, D 3). Dissolution kinetics were studied in hydrochloric acid solution, acetic, and phosphate buffer solutions, using an impeller mixer. The amount of dissolved drug was measured using high-performance liquid chromatography with ultraviolet detection. We used our own results along with data obtained from publicly available sources.

Results. The dissolution kinetics profiles of the generic drugs were similar to that of the reference drug. The dissolution speed of rivaroxaban from D 1 was not different from that of the reference drug D 0, which may be due to the use of a similar micronized form of the active ingredient. The results obtained for D 2 do not allow for a direct comparison because of the use of different dissolution media (including surfactants) in the experiments.

Conclusion. The use of a micronized active ingredient may give D 1 an advantage in the speed and completeness of dissolution, and predetermine high reproducibility of pharmacokinetic parameters in clinical use.