ISSN (print): 2412-4036, ISSN (online): 2713-1823 Founder: All-Russian public organization “Russian Scientific Medical Society of Internal Medicine” (RSMSIM) Editor-in-Chief: Zhanna D. Kobalava, corresponding member of RAS, Doctor of Sc., Full Professor Frequency / Assess: 10 issues per year / Subscription Included in: Higher Attestation Commission List, RISC
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Correction of cardiovascular risk factors and metabolic health indexes in patients with type 2 diabetes mellitus during semaglutide therapy
Prevention of macrovascular complications in patients with diabetes mellitus should be comprehensive and include adequate correction of the glycemic profile, blood pressure (BP), lipid profile parameters, and weight loss. The aim: to estimate the efficacy of the domestic drug semaglutide in regard to cardiovascular risk factors in patients with type 2 diabetes mellitus (T2DM), including parameters of glycemic control, lipid metabolism, weight and body composition dynamics, in a real clinical practice in the Republic of Mordovia. Material and methods. The study included 30 patients aged 33–64 years with T2DM and overweight or obesity who had not achieved target carbohydrate metabolism control while being on metformin therapy. All the studied were additionally prescribed semaglutide. Observation period was 24 weeks. Results. In 6 months study participants experienced an average reduction of systolic BP by 9.25%, diastolic BP by 4.8%, fasting plasma glucose by 27.91%, and glycated hemoglobin by 34.6%. Target glycated hemoglobin levels were achieved by 93.1% of patients. In addition, study participants had reductions in total cholesterol, LDL cholesterol, non-HDL cholesterol, and triglyceride levels. According to bioimpedance analysis, adipose mass decreased by an average of 19%, while active cell and skeletal muscle mass (by an average of 2 kg) and basal metabolic rate (BMR) increased. Conclusion. In real clinical practice, using of semaglutide at a dose of 1 mg once weekly for 6 months in combination therapy with metformin, helps to achieve target blood glucose and glycated hemoglobin levels in the vast majority of patients with T2DM, improving BP control, blood lipid profile, and anthropometric parameters by reducing adipose tissue mass while at the same time maintaining skeletal muscle mass.
Estimation of fibrosis markers’ level in individuals with different obesity phenotypes
Among obese individuals, a subgroup with moderate cardiometabolic risks and a positive prognosis is of profound interest. This phenomenon is actively studied and has been termed as metabolically healthy obesity (MHO). A search for predictors of adverse prognoses for the development of obesity-associated diseases in individuals with various phenotypes is currently underway. Adipose tissue activity results in systemic inflammation, which ultimately leads to the development of fibrosis in various organs and tissues. However, in routine clinical practice, fibrosis diagnosis is quite difficult due to the high cost and invasiveness of its methodics. Therefore, noninvasive estimation methods are being explored, for example, such as by measuring the serum fibrosis markers galectin 3 (Gal-3) and transforming growth factor beta 1 (TGF-β1). The aim: to assess the levels of serum fibrosis markers in individuals with different obesity phenotypes. Material and methods. The study included 76 individuals with obesity diagnosis. Two statistically homogeneous groups were formed: those with MHO (n = 35) and those with metabolically unhealthy obesity (MUHO, n = 41). Metabolic phenotyping was performed according to NCEP ATP III criteria. Gal-3 and TGF-β1 levels were measured in all participants using enzyme-linked immunosorbent assay. Results. Median Gal-3 level in MHO and MUHO groups did not differ statistically significantly: 0.3 [0.16; 0.42] and 0.23 [0.1; 0.33] ng/mL, respectively (p = 0.074). There were also no statistically significant differences in TGF-β1 levels between the groups: its median was 1.95 [1.43; 2.7] pg/mL in MHO group and 2.4 [1.62; 3.13] pg/mL in MUHO group (p = 0.265). Conclusion. The presence of MHO phenotype is likely not a stable or reliable marker of future favorable prognoses regarding the development of obesity-associated diseases.
Diagnosis of myocardial fibrosis in arterial hypertension: an experimental study
Myocardial fibrosis is a global medical problem, as far as it is associated with almost all forms of cardiovascular disease, including arterial hypertension (AH). The aim: to determine the development of myocardial fibrosis in an experiment on laboratory animals using morphological and biochemical research methods. Material and methods. The study included 24 Wistar rats aged 13–14 weeks, in which hypertension was modeled by removing one of their kidneys (experimental group). The control group consisted of sham-operated rats, which underwent a translumbar approach without kidney removal, followed by wound closure (n = 6). Blood for the study was collected from the inferior vena cava after euthanasia of the animals and subjected to enzyme-linked immunosorbent assay using kits for transforming growth factor beta (TGF-β) level determination. Results. The average systolic blood pressure in the experimental group in the first month of the experiment was 167 mmHg, diastolic – 89 mmHg. In the 2nd month, similar indexes were 178 and 95 mm Hg, in the 3rd – 152 and 92.6 mm Hg, in the 4th – 173.3 and 98.6 mm Hg, in the 5th – 180.6 and 102 mm Hg, in the 6th month – 161.3 and 90.6 mm Hg. When analyzing plasma TGF-β levels, the average TGF-β level in the control group was 7.4 ng/ml at month 2, 9.13 at month 4, and 8.57 ng/ml at month 6. In the experimental group, the average TGF-β concentrations at the same time points were 20.48, 18.24, and 15.6 ng/ml, respectively (p <0.05). Conclusion. The development of myocardial fibrosis in rats from the experimental group with arterial hypertension was confirmed by a significant increase in plasma TGF-β levels comparatively to animals in the control group. Using of this biomarker may be promising for predicting the development of hypertension complications, such as myocardial infarction, cardiac rhythm and conduction disorder, acute cerebrovascular accident.
To the aspect of diabetes mellitus prevention program among the population of the Novosibirsk Region
The prevalence of type 2 diabetes mellitus (T2DM) is growing at a pandemic rate; at this time its precursor, prediabetes, affects up to 10% of adults in Russia, most of whom are unaware of having that condition. Early identification of individuals with high risk for T2DM is a key area of its prevention. The aim: to assess the dynamics of T2DM risk factors among adults in the Novosibirsk Region from 2019 to 2023. Material and methods. As part of the “Let’s take care of health together!” program, health centers organized surveys using international FINDRISC riskometer and rapid analysis of blood glucose and cholesterol levels in apparently healthy visitors (exclusion criteria: age < 18 years, history of diabetes mellitus). Results. Over 5 years, no significant increase was observed in the proportion of individuals at high or very high risk for T2DM: it remains stable at approximately 17%. A moderate decrease in the prevalence of obesity (from 23 to 21%) and overweight (from 38 to 33%) was fixed. A combined elevated blood glucose and cholesterol level was found in 23% of respondents, which was most common in high-risk groups for T2DM. A combination of three or more significant risk factors (obesity, family history, hyperglycemia) was observed in almost all respondents at high risk for developing this type of diabetes. Conclusion. Despite the lack of significant increase in the proportion of individuals at high and very high risk for T2DM development, the stagnation of these indexes highlights the need to strengthen preventive measures aimed at modifying lifestyle and raising public awareness about prediabetes.
Prevention of progression of chronic heart failure with preserved ejection fraction: estimation of the correlation between NT-proBNP levels and clinical and functional characteristics during control of the disease
A promising direction of modern medicine development is the implementation of point-of-care diagnostic methods, which allows to optimize primary and secondary prevention, as well as treatment strategies for patients with chronic non-infectious diseases. The aim: to evaluate the correlation between N-terminal propeptide of B-type natriuretic hormone (NT-proBNP) level and clinical and functional parameters in patients with chronic heart failure with preserved ejection fraction (CHFpEF) to optimize secondary prevention strategies. Material and methods. Current research work was performed from November 1, 2022, to December 1, 2024, at Novosibirsk Regional Clinical Hospital for War Veterans No. 3. The study included 149 individuals (96 male and 53 female) with a history of myocardial infarction and CHFpEF. Their clinical and functional characteristics were assessed, and NT-proBNP concentrations in the blood were measured using the NT-proBNP K rapid test. Results. A statistically significant correlation was found between NT-proBNP level measured using the rapid test and left vpentricular ejection fraction (r = -0.335; p < 0.01), 6-minute walking test results (r = -0.230, p < 0.01), RSCS indexes (r = 0.650, p < 0.01), as well as with main clinical characteristics of CHF – pulmonary rales (r = 0.626, p < 0.01), orthopnea (r = 0.516, p < 0.01), edema (r = 0.465, p < 0.01), shortness of breath (r = 0.396, p < 0.01), coughing (r = 0.369, p < 0.01). Conclusion. Regular NT-proBNP monitoring serves as a secondary prevention tool, enabling preclinical diagnosis of cardiac dysfunction and timely treatment. A rapid, quantitative method for determining this biomarker has significant diagnostic potential in internal medicine for patients with CHFpEF.
Efficacy of the use of phytotherapy – thyme and ivy liquid extract – in rehabilitation after coronavirus infection
The development of effective rehabilitation methods after coronavirus infection as a preventative measure for arising of chronic bronchopulmonary pathology is an actual point in medical practice. In this context, phytotherapy using thyme and ivy liquid extract, which has a complex effect – expectorant, secretolytic, broncholytic, anti-inflammatory, antimicrobial, and antiviral – is of interest. The aim: to evaluate the efficacy of thyme and ivy liquid extract in rehabilitation of patients after coronavirus infection still having persistent cough. Material and methods. A non-randomized prospective cohort study was performed among 281 patients aged 18 to 72 years who had recovered from mild to moderate COVID-19 infection and still had persistent cough. 73 patients with bacterial pneumonia and 46 individuals with newly diagnosed chronic bronchopulmonary disease were excluded from the study. Patients were seeking medical care as outpatients in real clinical practice. 49 participants were treated with oral ambroxol, 56 with acetylcysteine, and 57 with liquid ivy leaf extract and thyme herb extract (Bronchipret® syrup). The duration of therapy in all cases was 10–14 days. Results. Mucolytic therapy for acute bronchitis after coronavirus infection that was used in the study demonstrated a positive clinical effect in 82–84% of cases, in case of good tolerability of the drugs. At the same time, the efficacy of the mucolytics used varied. Thyme and ivy liquid extract demonstrated several advantages over ambroxol and acetylcysteine, including its higher overall efficacy, with complete relief of respiratory complaints in 73.2% of patients, significant resolution of opal-glass opacities in 75%, and also accelerated regression of respiratory symptoms within a week, which prevented post-COVID syndrome. Conclusion. Use of phytotherapy with thyme and ivy liquid extract for persistent respiratory complaints following coronavirus infection is an effective and safe rehabilitation method due to the multifunctionality of the components of the drug.
Study of unsaturated fatty acids profile in male individuals with obesity, including abdominal obesity, from Novosibirsk region
Effects of fatty acids (FA) and mechanisms of changing their profile in human body due to obesity are still remaining understudied and are actively being researched. The aim: to evaluate plasma unsaturated fatty acid levels in male individuals aged 35–74 years with obesity, including abdominal obesity, in Novosibirsk region, and also to assess the association between FA level and the presence of obesity. Material and methods. 300 male individuals from rural areas of Novosibirsk region (mean age 56.4 ± 11.5 years) were included into monocentric observational cross-sectional study. Participants with a BMI of 25.0–29.9 kg/m² were considered having overweight, a BMI of 30.0–34.9 kg/m² was considered as a class 1 obesity, BMI of 35.0–39.9 kg/m² was considered as a class 2 obesity, and a BMI ≥ 40 kg/m² was considered as a class 3 obesity. Waist circumference > 94 cm was diagnosed as abdominal obesity. Using gas chromatography with mass-selective detection in blood plasma, the following unsaturated FA were measured: omega-3 alpha-linolenic, eicosapentaenoic, and docosahexaenoic; omega-6 linoleic, gamma-linolenic, dihomo-gamma-linolenic, arachidonic, docosatetraenoic, and docosapentaenoic; omega-9 hexadecenoic, oleic, mead, and selacholic. Results. Mead FA levels were higher in males with abdominal obesity comparatively to those without this condition. Furthermore, the levels of this FA were statistically significantly different between males with BMI ≥ 25.0 kg/m² and those with normal BMI. Individuals with stage 3 obesity had higher levels of docosahexaenoic and docosapentaenoic acid comparatively to participants with normal BMI (p = 0.023 and p = 0.020, respectively). The probability of obesity was directly associated with increased levels of docosahexaenoic and mead FA, while abdominal obesity was associated with increased mead FA levels (odds ratio 1.054; 95% confidence interval: 1.008–1.101, p = 0.020). Conclusion. Elevated mead FA level may serve as an additional informative biomarker indicating a high risk of obesity in male individuals.
Clinical experience of using umifenovir for ARVI prevention during its seasonal increase in patients with secondary immunodeficiency conditions
According to the data of World Health Organization, approximately 1 billion cases of seasonal acute respiratory viral infections (ARVI) are registered annually worldwide. About 3 million to 5 million of them are severe cases, resulting in 290,000 to 650,000 deaths from grippe-related respiratory complications. Patients with comorbidities, including secondary immunodeficiency conditions, are particularly vulnerable in that case. The aim: to determine the prophylactic efficacy of antiviral drug umifenovir when administered at a therapeutic dose during the seasonal increase in ARVI incidence in a group of patients diagnosed with secondary immunodeficiency conditions. Material and methods. A non-interventional study was performed in a group of patients with secondary immunodeficiency conditions during the 2024/2025 peak epidemic season. Results. Umifenovir intake was recommended for 269 patients. A total of 197 (73%) participants followed the doctor’s recommendations, of whom 45 (22.8%) developed mild acute respiratory viral infection. In the group who did not take the drug, the number of cases was 72 (59.7%). Conclusion. Non-interventional study demonstrated the efficacy of umifenovir, which resulted in a significant reduction in the incidence of grippe and acute respiratory viral infection in individuals with secondary immunodeficiencies, also it reduced risk of complications.
Efficacy of antioxidant therapy in reducing visceral obesity among overweight individuals
Oxidative stress is a significant pathogenetic factor in the development and progression of visceral obesity. Standard approaches based on lifestyle modification (LM) are often insufficient to achieve clinically significant reductions in visceral fat depots. The aim: to comparatively evaluate the efficacy of three therapeutic strategies (ethylmethylhydroxypyridine succinate 250 mg 3 t.i.d. + LM; ethylmethylhydroxypyridine succinate 250 mg 3 t.i.d. alone; LM alone) on visceral fat dynamics in overweight female patients. Materials and methods. The study included 75 overweight female patients (mean age 32.9 ± 0.9 years), randomized into three groups depending on the therapeutic strategy. Estimation of anthropometric parameters, visceral fat indexes (bioimpedance analysis), and lipid profile was made at baseline and after 3 months of therapy. Results. Treatment with ethylmethylhydroxypyridine succinate resulted in a statistically significant reduction in visceral fat mass and area comparatively to monotherapy performed alone (p < 0.001). The most pronounced effect was observed with combined use of the drug and monotherapy, which was superior to pharmacological monotherapy (p = 0.0136). Furthermore, the dynamics of lipid profile in the treatment groups was characterized by increase in LDL cholesterol, non-HDL cholesterol, and atherogenic index, while no significant changes in these parameters were observed. Conclusion. Ethylmethylhydroxypyridine succinate significantly reduces visceral fat in overweight female individuals, especially in combination with LM. Combination approach is the most effective strategy for correcting visceral obesity. These data highlight the need for further study of the effects of antioxidant therapy on lipid metabolism parameters and metabolic risk.
Early diagnosis and risk estimation of cardiovascular diseases: epidemiology, relevance, and comparative analysis of approaches in Russia, in the EU, and in the USA
Cardiovascular diseases (CVDs) remain the leading cause of death, creating a significant socioeconomic burden for countries worldwide. Early diagnosis and risk assessment of CVDs are critical to reducing morbidity and mortality. The aim of the current review is to compare all major approaches to early diagnosis and risk assessment of CVDs in Russia, in the European Union, and in the United States. It highlights current data on the epidemiology of CVDs, gender and age differences in their prevalence, associated economic costs, frequency of various diagnostic procedures, and the extent of screening. The efficacy of CVD diagnostic algorithms and the use of the Systematic Coronary Risk Evaluation 2 (SCORE2) and Atherosclerotic Cardiovascular Disease (ASCVD) prognostic risk scores are considered. Also cardiovascular mortality rates and screening coverage in rural and urban areas of Russia, in the European Union, and in the United States are presented. The conclusions from the article highlight the need to strengthen the prevention and diagnosis of CVDs, particularly in Russia.
Ideal marker of renal glomerular filtration rate: myth or reality?
Estimation of kidney function is important in modern diagnostics due to the increasing prevalence of renal diseases. According to the Global Burden of Disease, the number of new cases of chronic kidney disease in the world increased by 25% in 2012–2021. Early detection of renal damage can improve the prognosis of the disease in a particular patient, reduce mortality and the need for replacement therapy. A common method for renal function assessing is the analysis of glomerular filtration rate (GFR). It is considered to be an indicator of renal function, since it decreases with kidney damage. The most common marker for GFR assessment is creatinine. However, its level has significant individual variability and a blind range, and with a decrease in glomerular filtration of creatinine, tubular secretion increases. In this regard, the aim of the review was to analyze the literature data and data of clinical studies concerning renal function markers based on GFR, as well as their comparison based on the characteristics of the “ideal” marker.
Azilsartan at the start of arterial hypertension therapy: results of EDARGO-START study
Arterial hypertension (AH) remains the leading cause of cardiovascular morbidity and mortality. At the same time, blood pressure (BP) control in real clinical practice remains insufficient. Current guidelines emphasize the importance of effective initial therapy of this disease, but the choice of the optimal renin-angiotensin-aldosterone system blocker remains controversial. The aim: to compare the efficacy and safety of azilsartan medoxomil and angiotensin-converting enzyme (ACE) inhibitors prescribed as initial therapy in previously untreated patients with AH. Material and methods. EDARGO-START is a multicenter, prospective, non-interventional study performed in Russia in 2024–2025. The study included 359 patients with stage 1–2 essential AH and was followed for 12 weeks. Participants received azilsartan medoxomil at doses of 20–80 mg or an ACE inhibitor (mono- or combination therapy). Dynamics of office BP and indexes of daily BP monitoring, frequency of achieving its target values, tolerability and safety of therapy were assessed. Results. All groups demonstrated significant reductions in office systolic (by 22–28 mmHg) and diastolic (by 12–15 mmHg) BP by the 12th week. More than 90% of patients achieved the target BP level of < 140/90 mmHg, and approximately 50% achieved the target BP level of < 130/80 mmHg, with no intergroup differences. The greatest absolute reduction in systolic BP was observed with azilsartan 80 mg use. In a quasi-randomized analysis, azilsartan was significantly superior to ACE inhibitors in reducing systolic BP in patients with moderate to high cardiovascular risk (p <0.05). Adverse reactions were absent in all azilsartan groups, whereas they were observed in approximately 2% of patients in ACE inhibitors group. Conclusion. Azilsartan medoxomil is an effective and safe drug for initial therapy in case of AH and can be considered as a preferred antihypertensive treatment option, especially in patients with high cardiovascular risk, in real clinical practice.
Progressive familial intrahepatic cholestasis: literature review and clinical case
Progressive familial intrahepatic cholestasis (PFICH) is a group of autosomal recessive disorders manifesting primarily in childhood, less commonly in adulthood, and leading to liver cirrhosis development. Current article presents a narrative review discussing the genetic prerequisites, pathogenesis, diagnostic peculiarities, and current approaches to the treatment of PFICH, as well as a clinical observation of a patient with type 1 PFICH.
Conservative treatment strategy of degenerative meniscus injury
Article presents a clinical case of a patient with degenerative medial meniscus tear, discussing the choice of treatment between arthroscopic intervention and local injection therapy (LIT). A 71-year-old man with a posterior horn tear of the medial meniscus received conflicting opinions from traumatologists: one specialist recommended arthroscopic meniscus repair, while the other recommended conservative therapy. The patient underwent local injection therapy (LIT) using a regimen consisting of two injections of 2.5% hyaluronic acid (Flexotron® Ultra) and a course of polynucleotides (Chronotron), followed by another hyaluronic acid injection. Upon completion of the treatment course, the patient’s pain subsided, and surgery was not required. Magnetic resonance imaging (MRI) showed no significant negative changes after two years. This case demonstrates the efficacy of LIT for degenerative meniscal injury and emphasizes the need to use all available conservative treatment options before considering arthroscopic intervention.
New opportunities in therapy for severe bronchial asthma
Controlling the symptoms of bronchial asthma (BA), especially in severe cases, is one of the most difficult tasks in modern pulmonology. In recent years, with identification of so-called T2 and non-T2 endotypes of the disease, approaches to BA therapy titration have changed significantly. Genetically engineered biopharmaceutical drugs are prescribed at the fifth stage of treatment, i.e., when other treatment options fail to provide adequate control over the symptoms. One such a drug is tezepelumab, a thymic stromal lymphopoietin inhibitor. Clinical trials have shown that it significantly reduces the frequency of exacerbations and the severity of bronchial obstruction, improves symptoms control, and is well tolerated by patients. The aim of the introduced review is to study current approaches to the treatment of severe bronchial asthma.
Vascular cognitive impairments: the role of cerebral energy metabolism disorders
Cognitive impairments (CI), which are widespread in the population, are one of the main symptoms of vascular brain damages. Their presence significantly affects patients’ life quality and requires early detection and correction. Understanding of CI has significantly expanded due to the introduction into clinical practice of various neuroimaging techniques and results of research work in the sphere of fundamental pathochemical changes in brain’s antioxidative system. Vascular CI represent a heterogeneous group of cognitive disorders, ranging from mild to dementia-like ones. Diabetes mellitus and other metabolic disorders significantly contribute to the development and clinical manifestation of cerebrovascular pathology. Keys to effective prevention and treatment of vascular cognitive impairments are risk factor correction, early detection of changes in cognitive function, and timely initiation of comprehensive therapy, including cognitive training and medications that enhance the physiological antioxidant system and inhibit the formation of reactive oxygen species and other free radicals.
Aspects of remote blood pressure monitoring in follow-up care organization for very high cardiovascular risk patients
Using of automated remote monitoring systems is considered as a way to improve the treatment outcomes for patients with high and very high cardiovascular risk (CVR) and arterial hypertension in the frames of regular follow-up monitoring. The aim: to study the efficacy of remote blood pressure monitoring (RBPM) in organization of regular follow-up monitoring among working-age patients having very high CVR. Material and methods. A single-center prospective observational study included working-age and older residents (18–75 years) of Primorsky Region with very high CVR. When analyzing RBPM results after 12 weeks of follow-up, target BP values were defined as mean values less than 140 and 70 mmHg. Patients who achieved and did not achieve target BP were compared according to various biochemical parameters. Results. Initially the study included 150 patients with stage III arterial hypertension; 78 (52%) of them completed the study. 55 (70.5%) participants achieved mean BP values in the target range of 120–130/70–79 mmHg, of which 12 individuals had a tendency toward systolic arterial hypotension without statistical significance (121 [114–129] mmHg at baseline versus 109 [107–116] mmHg after 12 weeks, p = 0.72). In 23 (29.4%) patients, mean BP was outside the target range (121 [114–129] versus 142 [134–146.5] mmHg, p = 0.034). According to our data, a group of patients with a more unfavorable cardiometabolic risk profile, including reduced glomerular filtration rate, require more intensive outpatient BP monitoring and, if necessary, adjustment of the antihypertensive therapy and associated risk factors. Conclusion. The aspect of use of RBPM as a part of the follow-up care of patients with high and very high CVR arterial hypertension in real-world clinical practice requires to be further studied, including a multicenter national study, to determine the balance between the maximum effect of follow-up care and cost-effectiveness.
A fresh angle on nutritional support in chronic kidney disease: PLADO nutritional model
Chronic kidney disease (CKD) is accompanied by decreased kidney function and an increased risk of cardiovascular mortality. Properly selected diet can play a significant role in slowing the progression of that disease. Low-protein diet with a predominance of plant sources (PLADO – Plant-DOminant low-protein diet) is a promising dietary strategy in case of CKD. Combination of reduced protein intake and increased dietary fiber intake helps preserve kidney function, reduce systemic inflammation, optimize metabolic status, and reduce cardiovascular risk. Despite the proven benefits of PLADO food spectrum, there are several limitations to its use, so support from a dietitian is essential for comprehensive care and effective treatment outcomes for patients with CKD. Our review summarizes current evidence regarding the physiological basis of PLADO diet, its clinical efficacy, advantages, and potential disadvantages, with the aim of providing a comprehensive resource for clinical practice.
Influence of ipragliflosin on cardiac electrical activity in patients with type 2 diabetes mellitus and arterial hypertension
Over the past decade, sodium-glucose cotransporter-2 inhibitors have demonstrated clinical benefits in the treatment of cardiovascular diseases. The aim: to evaluate the effect of ipragliflozin at cardiac electrical activity in patients with type 2 diabetes mellitus (T2DM) and arterial hypertension (AH). Material and methods. A prospective cohort study was performed at the basis of the Department of internal medicine and family medicine, Omsk State Medical University of the Ministry of Healthcare of Russia and Clinical Cardiology Dispensary. Thirty patients with T2DM and arterial hypertension participated in the study: 14 male and 16 female individuals (mean age 54.0 [50.0; 60.0] years). They took ipragliflozin at a dose of 50 mg once daily for 12 weeks. All participants underwent comprehensive laboratory and instrumental examinations, including echocardiography and , Holter electrocardiogram monitoring, at baseline and after 12 weeks. Results. Baseline clinical status of patients with T2DM, AH, and left ventricular diastolic dysfunction was characterized by complaints of rapid heart rate in every second case, insufficient reduction of heart rate in nighttime, rigid circadian index, episodes of sinus tachycardia, supraventricular and ventricular extrasystoles, decreased R-R variability, increased activity of sympathetic nervous system. After 12 weeks of ipragliflozin therapy, positive subjective dynamics was observed, associated with a reduction in the number of recorded episodes of supraventricular and ventricular extrasystoles. Conclusion. Obtained study data indicate that ipragliflozin has a positive effect on cardiac electrical activity in patients with T2DM and AH without atherosclerotic cardiovascular diseases.
Estimation of some myocardial electrical instability indexes in patients with obesity
Cardiovascular diseases (CVD) are the leading cause of mortality worldwide. Obesity is a major risk factor for CVD and is associated with growing of overall mortality, as it potentially increases the risk of sudden cardiac death (SCD). Such indexes as increased QT dispersion and decreased heart rate variability (HRV) serve as markers of myocardial electrical instability (MEI) and independent risk factors for SCD development. The aim: to estimate certain MEI indexes in obese patients. Material and methods. The study included 62 patients divided into three groups: Group 1 – 14 healthy individuals, Group 2 – 19 patients diagnosed with stage I–III obesity, and Group 3 – 29 patients diagnosed with stage I–III obesity and type 2 diabetes mellitus. Clinical examination of the participants included questionnaire, blood pressure measurement, anthropometric assessment (height, weight, body mass index, waist and hip circumference), 24-hour electrocardiogram monitoring (EM-ECG). EM-ECG included assessment of heart rate, HRV parameters (avNN, pNN50, SDNNidx, SDNN, SDNNidx, RMSSD, VLF, LF, HF), QT interval. Results. Comparatively to healthy controls, patients in Group 2 showed a decrease in overall HRV parameters: SDNN by 86% and SDNNidx by 79% (p <0.05). In Group 3, SDNN, pNN50, and SDNNidx were reduced by 79, 42, and 72% (p <0.05), respectively, relative to healthy controls. Furthermore, comparatively to healthy controls, patients in group 2 showed a decrease in VLF and LF by 69 and 60% (p <0.05), while patients in group 3 showed a decrease in LF and HF by 52 and 38% (p <0.05), respectively. Conclusion. An analysis of EM-ECG parameters in patients included in the study revealed a decrease in HRV, most pronounced in those with combination of obesity and type 2 diabetes mellitus, which is considered to be a marker of MEI and a risk factor for SCD. In patients with obesity, decreased parasympathetic and increased sympathetic nervous system activity are observed. A decrease in LF and HF parameters reflects a nervous system imbalance in patients with a combination of obesity and type 2 diabetes mellitus.
The role of bradykinin as a pathogenetic target and prospects for pharmacological correction of cough associated with angiotensin-converting enzyme inhibitors: results of an open-ended prospective observational program
Cough induced by angiotensin-converting enzyme (ACE) inhibitors is a common side effect that can be managed with antitussive therapy. The aim: to evaluate the efficacy of antitussive drug Rengalin® in the treatment of cough induced by long-term use of an ACE inhibitors. Material and methods. The study included 30 patients with persistent cough associated with ACE inhibitor use. Participants received Rengalin®, two tablets twice daily, for 28 days, while maintaining their ACE inhibitor intake. During visits 1–5 (days 1, 7, 14, 21, and 28 of the observation period), patients were examined, cough severity was assessed, completion of the cough severity Scale in the patient’s diary was verified, and concomitant therapy was recorded. From the second visit, data on adverse events was collected, and treatment efficacy was assessed. The primary endpoint was change in cough severity on days 7, 14, 21, and 28 of the treatment and observation. Additionally, the influence of therapy at nighttime and daytime cough, proportion of patients without cough, and time to cough resolution were estimated. Results. After a 28-day course of Rengalin® intake, a decrease in cough severity from 6.7 to 0.1 points was observed (p <0.0001). Antitussive effect of the drug was fixed on the 7th day of therapy, with a decrease in cough severity from 6.7 to 5.0 points. Cough resolution (both daytime and nighttime) was recorded in 27 patients (90%) by the 21st day of treatment, and in 29 patients (96.7%) by the 28th day of treatment. No serious adverse events of the studied drug or negative impact on vitally important indexes were recorded. Conclusion. Rengalin® demonstrated a significant antitussive effect in patients with ACE inhibitor-induced cough, achieving almost complete relief of this symptom in most patients by the end of the 4-week course of therapy. This may take place due to its regulatory effect on bradykinin receptors.
Digest of interregional scientific and practical events under the aegis or with the participation of RSMSIM (November – December 2025)
Andrey Georgievich Malyavin (29.07.1958 - 01.12.2025)