Vol 6, No 3 (2025)

BACKGROUND: Acute brain injury is frequently associated with a hypermetabolic/hypercatabolic syndrome. Both hypo- and hyper-nutrition have a negative effect on treatment outcomes. However, the actual energy needs in this group of patients are poorly understood.

AIM: This study aimed to compare the energy needs in patients with acute, severe brain injuries with those of patients at high risk, using equations and indirect calorimetry data.

METHODS: This prospective, comparative, observational, open-label study included patients with severe acute brain injury and those at high risk of severe central nervous system injury. All patients received neurovegetative stabilization and enteral nutrition. Energy needs were determined using indirect calorimetry and equations such as the Harris-Benedict equation for spontaneously breathing patients, and the Penn State equation for mechanically ventilated patients. Measurements were taken at the start of neurovegetative stabilization, on day 2, and at the end of treatment. Enteral nutrition was prescribed based on indirect calorimetry data. The patients were divided into two groups: one group with an acute cerebrovascular accident (CVA), or acute brain injury, and another group with arteriovenous malformation (AVM) at a high risk of CVA.

RESULTS: The study included 18 patients (8 men, 10 women; mean age: 53 ± 17 years). Nine patients (50.0%) had hemorrhagic CVA, 2 patients (11.1%) had ischemic CVA, and 7 patients (38.9%) had AVM. Sixteen patients (88.9%) underwent surgery. Indirect calorimetry showed that the basal metabolic rate in the CVA group was higher than in the AVM group: 1584 ± 1131 kcal/day vs 1236 ± 198 kcal/day on day 1, and 1605 ± 738 kcal/day vs 1167 ± 303 kcal/day on day 2. Upon neurovegetative stabilization completed on day 10, the basal metabolism rate stabilized at 1676 ± 628 kcal/day in the CVA group and 1606 ± 504 kcal/day in the AVM group.

The estimated basal metabolic rates in the CVA group were consistently higher than those in the AVM group: 1703 ± 610 kcal/day vs 1509 ± 482 kcal/day on day 1 and 1777 ± 677 kcal/day vs 1515 ± 512 kcal/day on day 2. After neurovegetative stabilization was completed on day 10, the estimated basal metabolic rates were 1789 ± 590 kcal/day in the CVA group and 1597 ± 490 kcal/day in the AVM group.

CONCLUSION: On day 1 of neurovegetative stabilization, indirect calorimetry revealed that the energy needs of most patients were lower than the estimated rates. After neurovegetative stabilization was completed, the actual energy needs slightly differed from the estimated ones.

Alternative diets have become widely used by patients with cancer, most of whom choose these diets on their own. The shortage of specialists with equal expertise in oncology, nutritional science, and gastroenterology contributes to an increase in self-medication and reliance on unqualified practitioners and unverified online sources. Therefore, evaluating the most popular diets is an urgent task. This work aimed to evaluate the validity of the most popular alternative diets as part of a combined supportive treatment strategy for patients with cancer, based on a review of publications. The following keywords were used to search relevant publications in PubMed and e-Library databases for the past 20 years: диета против рака (anti-cancer diet), альтернативная диета (alternative diet), рак (cancer), комплементарные методы лечения (complementary therapies), and клинические рекомендации (clinical guidelines). Based on the obtained data, the most popular diets in oncology practice are: the ketogenic diet, the Mediterranean diet, the Gerson diet, the Budwig diet, and the Breuss diet. We evaluated their compositions and effects on disease prevention, carcinogenesis, and overall survival. The justification and safety of prescribing these dietary regimens were considered. The data showed that the ketogenic and Mediterranean diets were the most extensively studied. Although the ketogenic diet is based on Warburg hypothesis, it does not have a significant antitumor effect. Moreover, some clinical studies have reported its carcinogenic potential. The Mediterranean diet is shown to be effective in preventing cancer, rather than its treatment. The Gerson, Budwig, and Breuss diets contradict fundamental principles of carcinogenesis and have no evidence base. Therefore, it is crucial to follow the nutritional support recommendations developed by international and Russian professional communities. These recommendations are based on substantial clinical data and sufficient evidence and prohibit risky diets for patients with cancer.

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a common complication in patients undergoing surgery under general anesthesia, manifesting as cognitive impairement. POCD is currently diagnosed primarily using neuropsychological tests. However, identifying the association between biomarkers of neuronal injury and POCD may provide an additional diagnostic tool. It is crucial to understand the pathogenetic mechanisms of POCD for proper diagnosis and treatment.

AIM: This work aimed to analyze and summarize the latest data on the development, management, and diagnosis of POCD in adult patients.

METHODS: A thorough search and analysis of publications from 2020 to 2025 was conducted using the PubMed and eLibrary databases.

RESULTS: The review of publications identified perioperative risk factors for POCD and potential diagnostic biomarkers such as tau protein, interleukin-1β (IL-1β), calcium-binding protein S100B, matrix metalloproteinase-9 (MMP-9), APOE ε4 allele, beta-amyloid (Aβ), and NF-κB (nuclear transcription factor kappa B) signaling pathway. These biomarkers show promise for diagnosing POCS and developing targeted therapies. Additionally, a systematic classification of cognitive dysfunctions developed by the International Research Group was described, which helps avoid misinterpretation of acute postoperative factors.

CONCLUSION: POCD is a common, multidisciplinary challenge requiring the timely identification of high-risk patients and treatment of modifiable factors during the perioperative period. Key tools for improving postoperative quality of life include rational anesthesia management with bispectral index monitoring; use of propofol and dexmedetomidine; implementation of standardized preoperative testing; and Prehabilitation and enhanced recovery after surgery (ERAS) principles.

Muscle atrophy and metabolic disorders are serious clinical challenges that substantially worsen the prognosis and increase the mortality rates in critically ill patients. Despite being widespread, traditional nutritional support remains ineffective in intensive care units. Therefore, it is crucial to evaluate alternative pathophysiological mechanisms of muscle atrophy.

This review of current publications identified anabolic resistance as a key factor reducing the effectiveness of standard nutritional support regimens for critically ill patients. In this condition, muscle tissue loses its ability to adequately respond to anabolic stimuli, such as amino acids or protein substrates. Pathophysiologically, anabolic resistance involves systemic inflammation, insulin resistance, immobilization, and bioenergetic muscle dysfunction. A stable isotope analysis revealed that anabolic resistance develops directly in muscle tissue rather than in the gastrointestinal tract. This explains why increasing protein intake alone is ineffective.

Clinical studies have shown that critically ill patients reduce protein uptake into their skeletal muscles by 60% compared with healthy individuals. However, gastrointestinal absorption remains intact. In anabolic resistance, inflammation is a more important factor than insulin resistance. Intensive care unit–acquired weakness leads to long-term functional impairment and complicates patient rehabilitation.

The analysis suggests that the current approaches to maintaining muscle mass in critically ill patients should be fundamentally revised. Instead of just increasing protein intake, new therapeutic strategies are needed to address intramuscular inflammation and impaired substrate utilization.