Vol 29, No 2 (2025): CARDIOLOGY

Relevance. Red cell distribution width (RDW), a marker of erythrocyte size variability, is considered a potential prognostic factor in cardiovascular diseases. Accurate risk assessment in acute myocardial infarction (MI) is crucial, yet identifying reliable prognostic markers remains essential for guiding clinical decisions and improving long-term survival. This study aims to investigate the prognostic value of RDW on admission for long-term mortality in patients with acute MI. Materials and methods. The prospective observational study included 577 MI patients who underwent coronary angiography within 24 hours of admission. Demographic data, vital signs, laboratory test data, and comorbidities were collected from the database. The clinical endpoint was 18‑month mortality. The associations between RDW, clinical parameters and clinical outcomes was evaluated using logistic regression and receiver operating characteristic (ROC) analysis. Results and Discussion. The median age of patients was 65 (interquartile range [IQR]: 56–74) years, 60.7% were male. The 18‑month mortality rate was 11.4% (n  =  66). Median RDW was 14.2% (IQR 13.5–15.0). RDW was correlated with age, history of coronary artery disease, previous MI, previous cerebrovascular accidents, atrial fibrillation, peripheral artery disease, hemoglobin, left ventricular ejection fraction and GRACE score. Patients with 18‑month mortality had significantly higher RDW values compared to survivors (15.0% vs. 14.1%, p  <  0.001). Higher RDW values were associated with an increased 18‑month mortality (quartile 1: 3.9%, quartile 2: 5.4%, quartile 3: 13.4%, quartile 4: 23.9%, p < 0.001). Univariate analysis revealed that RDW was associated with 18‑month mortality (odds ratio [OR]: 1.38; 95% confidence interval [CI]: 1.20–1.58, p < 0.001). Multivariate analysis revealed RDW as an independent predictor of 18‑month mortality (adjusted OR: 1.33, 95% CI: 1.12–1.58, p < 0.001). The area under the ROC curve of RDW was 0.708 (95% CI: 0.642–0.775, p < 0.001) for predicting 18‑month mortality. The optimal cutoff value of RDW to predict 18‑month mortality was 14.2% with a sensitivity of 78.8% and a specificity of 54.8%. Conclusion. Elevated RDW value on admission was associated with an increased risk of 18‑month mortality in patients with acute MI. RDW was an independent predictor of 18‑month mortality in patients with acute MI, highlighting its potential as a prognostic marker in this population.

Relevance. The respiratory system of patients with post-infarction left ventricle aneurysm and chronic heart failure is often characterized by decreased external respiratory function and the development of respiratory complications in the early postoperative period. Positive expiratory pressure therapy (PEP-therapy) is considered an effective method of respiratory rehabilitation after cardiac surgery. However, there is currently no data on the application of this technique in patients after LVGR (left ventricle geometric reconstruction). The aim: to study the functional state of the respiratory system in patients after LVGR in the early postoperative period using PEP-therapy. Materials and Methods. 57 patients after LVGR surgery were examined. Two groups of patients were identified: group I — patients undergoing PEP-therapy (n = 27), and group II — patients undergoing standard respiratory gymnastics (n = 30, control group). The study included 3 stages: I Stage — before surgery; II Stage — 2–3 days after surgery; III Stage — 10–12 days after surgery. Results and Discussion. At the preoperative stage, cardiorespiratory system disorders were found in groups I and II (FVC: 89.2% and 87.3%; EDV: 174.2 ml and 179.9 ml, respectively), as well as the risk of developing sleep-­disordered breathing (Oxygen desaturation index [ODI]: 7.1 and 6.7, respectively). On the second day after surgery, a significant decrease in all spirometry indicators was observed in both groups, with the ODI in groups I and II increasing by 2.9 (p < 0.001) and 3.1 (p  <  0.001) times, respectively. Chest CT revealed atelectasis in various parts of the lungs in 100% of the examined patients. Upon discharge from the hospital, group I after PEP-therapy showed better recovery of respiratory parameters compared to the control group (FEV₁: 22.1% vs 9.4%; PEF: 58.1% vs 19.5%, respectively). The ODI in group I returned to baseline values, and the number of patients with atelectasis decreased by 1.6 times. In group II, the ODI remained increased by 57.2%, and CT results remained unchanged. Conclusions: The use of PEP-therapy in the early period after LVGR surgery allows not only to reduce the number and volume of atelectasis but also to more effectively restore respiratory parameters and pulmonary gas exchange compared to the course of standard respiratory gymnastics.

Relevance. Cardiovascular diseases are the leading cause of death, and the current therapy is imperfect, as it has many side effects, and is ineffective for about a third of patients. In this review, we consider the role of oxidative stress in diseases of atherosclerotic genesis, such as type 2 diabetes mellitus and coronary heart disease. The key targets for molecular and cellular therapy of oxidative stress in diseases of atherosclerotic genesis can be, firstly, receptors localized on the cell membrane, the binding of which to the end products of glycolysis and proinflammatory interleukins leads to the activation of inflammatory cascades; secondly, antioxidant molecules, the content of which must be maintained at an optimal level both by alimentary and local infusion. Since the processes of β-cell damage and death are in most cases mediated by the activity of the NLRP‑3 inflammasome, it is necessary to study possible ways of destabilizing this protein complex, which help prevent the maturation and secretion of interleukins‑1β and –18. Conclusion. In addition to direct treatment, careful monitoring of biochemical markers signaling the onset of a pathological process is required, a tool for which can be tests for determining the antioxidant status. In addition, it is recommended to promote a healthy lifestyle among individuals prone to diabetes mellitus 2 and cardiovascular diseases, consisting of reducing the consumption of foods rich in fats and carbohydrates (in parallel with enriching the diet with fiber-rich, vitamins and preventing oxidative stress), increasing beneficial physical activity and quitting smoking.

Relevance. Stress is how a person interprets and reacts to situations deemed too stressful or dangerous for them. Medical students’ academic achievement and physical and mental health are frequently negatively impacted by stressful environments in medical institutions. Cardiovascular fitness is the most important physical fitness factor associated with health, and physical fitness is a potent health indicator. The maximum quantity of oxygen that a person can transport to their working muscles during intense exertion is measured by their maximum oxygen uptake or VO₂ max. When the connection between stress and physical activity has been studied, it has usually been from the standpoint of how exercise can improve mental health outcomes. Conclusion. Exercise and physical activity have been shown to positively impact mental health and the capacity to handle stressful situations. Additionally, it seems that exercise therapies enhance depression status.

Relevance. In today’s competitive environment, project management can ensure higher speed and quality of achieving strategic goals set for the healthcare industry at minimal cost and risk. Due to the need to implement regional projects with higher speed and quality, the problems of algorithmization of project management processes become relevant. The aim of the study was to find a prototype model for managing the processes of a medical organization project, built on formalized data of the functional components of the project and algorithms obtained during stage-by-stage modeling of the system. Materials and Methods. The research materials included scientific developments, manuals and works of Russian and foreign authors devoted to the economic and mathematical model of decision support in organizations of various types, the adaptive abilities of medical organizations implementing national projects in healthcare. Results and Discussion. The complex multi-­level system of project implementation in the healthcare industry, the instability of the external environment and the diversity of stakeholder needs require finding an algorithm for the implementation of management processes. As part of the research question, in the process of constructing, formalizing the operation of the system, its elements, the presentation of data on the prototype of the medical organization project is iteratively refined — in accordance with the data, the algorithms are simultaneously refined. To build a model of a prototype of management processes in a medical organization in the region for the purpose of subsequent digitalization, it is necessary to formalize the variables, determine in accordance with the size of the range of values ​​that this variable can take, for subsequent effective algorithmization of management processes. The authors consistently correlated the stages of project management processes with the classification characteristics of models to establish the stages of their construction and modeling of the working model of the project prototype. Conclusion. Having established an optimal (effective) prototype of the project’s management processes, it can be immediately integrated into the project environment of a medical organization using machine learning methods.

Relevance. The effect of the combined use of hoficin and remaxol on the indicators of metabolic intoxication and lipid peroxidation was studied in patients with chronic non-calculous cholecystitis on the background of diffuse liver diseases. Materials and Methods. The effect of the combined use of hoficin and remaxol was studied in 63 patients diagnosed with chronic non-calculous cholecystitison the background of acute chronic diffuse liver disease (CDLD), aged 20 to 53 years. Patients, by random distribution by age, gender, and severity of the clinical course of chronic non-calculous cholecystitis against the background of сhronic diffuse liver damage, were divided into two equivalent groups–the analyzed group, according to which the combined use of hoficin and remaxol and the control group using conventional treatment, after which the results were compared. In patients in the analyzed group, the level of middle molecules (MM) and the concentration of lipid peroxidation (POL) products, final malonic dialdehyde (MDA) and intermediate diene conjugates (DC) in the blood serum were studied. The screening method of V.V. Nikolaichyk was used in the modification of Gabrilovich. To study the level of medium molecules, blood serum was obtained by centrifugation at 4000g for 15 minutes. The method is based on plasma purification from high-molecular peptides and proteins using trichloroacetic acid, a 10% solution, and then the level of medium-­molecular peptides in terms of absorption in a monochromatic light stream was determined using direct spectrophotometry (at a wavelength of 254 nm) of the liquid. Results and Discussion. The content of MDA in blood plasma was estimated by M. Ushiama et al. in reaction with thiobarbituric acid. The studies were carried out in dynamics–before and after treatment. In patients with chronic non-calculous cholecystitis, an increase in serum MM levels and an increase in the concentration of POL products is observed. The use of the herbal preparation hoficin in combination with remaxol contributes to the normalization of clinical and laboratory signs of the disease, normalization of POL products. Under the influence of hoficin in combination with remaxol, the metabolic intoxication syndrome is eliminated, which is manifested by a significant decrease in the level of medium-­weight molecules to the upper limit of the norm, that is, this indicator is completely normalized, and the positive effect of treatment is observed in the first group of patients, unlike patients of the second group, in addition, the relative metabolic constancy of the internal environment of the body is restored. Conclusion. Patients with chronic non-calculous cholecystitis against the background of diffuse liver diseases exhibit endogenous metabolic intoxication syndrome. Increased concentration of LPO products-­MDA and DC indicates activation of biomembrane lipid peroxidation. Including the herbal preparation Hoffitsin in combination with Remaxol in the general treatment course of these patients contributes to normalization of clinical and laboratory disease indicators, medium molecule levels decrease to normal, and LPO products-­MDA and DC normalize. Under the influence of Hoffitsin in combination with Remaxol, metabolic intoxication syndrome is eliminated and relative metabolic constancy of the body’s internal environment is restored.