Коррекция питания является основой российских и зарубежных рекомендаций по лечению атеросклероза, стабильных и нестабильных форм ишемической болезни сердца. Благодаря правильно подобранному сбалансированному рациону возможно достижение целевых показателей липидного профиля. Поэтому назначение диеты является обязательным и самым первым компонентом в лечении любых форм атеросклероза. Анализ научной литературы с использованием библиографических баз NCBI, WoS, Scopus и РИНЦ показал, что наиболее приемлемы в профилактике и лечении атеросклероза вегетарианская и веганская диеты, достоверно снижающие риск развития и прогрессирования атеросклероза, осложнений и смертности. Это связано с тем, что растительные волокна препятствуют всасыванию холестерина и способствуют нормализации микрофлоры кишечника. Содержащиеся в овощах, фруктах, ягодах, чае и зерновых полифенолы препятствуют агрегации тромбоцитов и воспалительным процессам, способствуют улучшению состояния эндотелия и соотношения липопротеинов крови. Антиатерогенными свойствами обладают соевый белок, витамин D, омега-3-жирные кислоты и многие другие описанные в обзоре компоненты. Для всеядных людей необходимо ограничение атерогенных продуктов, богатых холестерином, железом, сахаром, кальцием и фосфатами. Важное значение имеет способ приготовления, поскольку при жарке как растительных, так и животных продуктов образуются атерогенные вещества, способствующие воспалительным процессам в стенках артерий и дислипидемии.

Atrial fibrillation is one of the most common heart rhythm disorders associated with an increased risk of stroke, cardiovascular mortality and hospitalizations. The development of arrhythmias is influenced by a number of risk factors, including arterial hypertension, chronic heart failure, coronary heart disease and endocrine disorders. New guidelines from the European Society of Cardiology (2024) emphasize the importance of managing risk factors to improve treatment efficacy and prognosis in patients with atrial fibrillation. Sodium-glucose cotransporter type 2 inhibitors (gliflozins), originally used as hypoglycemic drugs, are now also widely used to reduce the risk of adverse cardiovascular events. However, the use of these drugs to reduce the risk of atrial fibrillation and improve the course of atrial fibrillation remains an open question. In order to find an answer to this question, a literature review was conducted, which showed that inhibitors of sodium-glucose cotransporter type 2 can theoretically have an antiarrhythmic effect realized through several mechanisms. Analysis of scientific data suggests that in most cases, the use of sodium-glucose cotransporter type 2 inhibitors reduces the risk of first-time atrial fibrillation, has a positive effect on the course of arrhythmia and reduces the risk of its recurrence after ablation. At the same time, it is not clear to the end whether the discussed issues are class-effect or the drugs belonging to the gliflozin group have different efficacy. The mentioned issues necessitate further prospective studies to confirm the antiarrhythmic effect in sodiumglucose cotransporter type 2 inhibitors.

Given the growing demand worldwide for online services, particularly among individuals engaged in diverse kinds of office work, this paper aims to analyze the literature data on teleconsultation for the prevention of work-related musculoskeletal discomforts among office workers. The findings of this review underscored a notable lack of attention to teleconsultation among office workers, coupled with insufficient education on utilizing this technology. It is recommended that companies prioritize the implementation of teleconsultation services to enhance the health and well-being of their employees, while also considering it as a cost-effective strategy.

Introduction. Diffuse B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin’s lymphoma. Currently, the standard method for evaluating patients at the initial stages of cancer diagnosis in Mashhad oncology centers involves computed tomography scans (CT scans), histopathological evaluation of tissue, bone marrow sampling, and cytogenetic studies, all of which are time-consuming and costly. It is worth mentioning that at present, the most recommended approach for determining lymphoma staging is the FDG-PET/CT scan, which combines labeled glucose with CT scan and offers a more accurate alternative. The objective of this study is to explore the potential of FDG-PET/CT scan as a tool for detecting high-grade lymphoma.

Methods. In this study, patients with different types of DLBCL who underwent FDG-PET Scan for staging at Razavi Hospital, Mashhad, Iran between 2017 and 2021 were examined. The necessary clinical and paraclinical information, including the stage of the disease, the involved site at the time of diagnosis, the result of immunohistochemical examination, and the response to treatment were collected. FDG-PET Scan information including the extent of involvement and metabolic activity of the tumor before the start of treatment, pathological characteristics of the tumor, clinical behavior, and response to treatment in the form of response rate (RR), disease-free survival (DFS) and overall survival (OS) of the patients. Was also investigated. Aggressive histology in the present study was classified based on morphological characteristics and immunohistochemical staining, prognostic indicators, clinical behavior and response to treatment. Data were analyzed using SPSS software at a significance level of p<0.05.

Results. Comparing the two groups of patients with high grade histology (n=12) and NOS (n=14), the results showed that SUV max values in patients with aggressive lymphoma were 27.5 ± 15.6 (median 25.6) and in patients with NOS lymphoma was 15.4 ± 9.8 (median 14.4) (p=0.01). The overall survival of patients in the aggressive group was 10 months and in the non-aggressive group was 24 months (p=0.002). Also, the cut — off -point of 21.1 for SUV max has a sensitivity of 66 % and a specificity of 72 % in differentiating aggressive from non-aggressive types.

Conclusion. The results revealed that FDG PET CT Scan can provide valuable insights into differentiating lymphomas with a more aggressive type from their usual types, as those with heightened metabolic activity (SUVmax) are often indicative of aggressive behaviors.

Understanding the risk factors for coronary in-stent restenosis is particularly important in patients with coronavirus disease (COVID-19). Such patients require careful monitoring, priority treatment, and prevention.

The aim of our study was to assess the association between clinical and laboratory parameters and previous coronavirus infection in patients with coronary artery restenosis.

Materials and methods. A cross-sectional study was conducted on a continuous sample of patients with coronary artery disease who underwent repeated myocardial revascularization in the period from 2020 to 2023 (931 patients). 420 patients in the main group had coronary artery stent restenosis, of which 162 (38.5 %) had suffered from coronavirus infection (CVI). The control group included 511 patients with repeated myocardial revascularization without stent restenosis, of whom 107 (20.9 %) had undergone CVI. Laboratory tests included troponin I, D-dimer, creatine kinase (CK), creatine kinase-MB (CK-MB), serum creatinine and glucose, C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and fibrinogen, IgG and IgM antibodies to coronavirus and RNA detection by polymerase chain reaction. Statistical calculations were performed using SPSS version 20.0 software.

Results: It was established that there were statistically significantly higher levels of IgG antibodies to coronavirus and C-reactive protein in the main study group compared to the control group. When dividing the study groups into subgroups of individuals with and without previous CVI, statistically significant differences in troponin levels were found (p<0.001): between the level in the group with restenosis and CVI compared to groups without restenosis with CVI, with restenosis without CVI, and in groups with revascularization without CVI and with restenosis without CVI. The levels of D-dimer, CPK, CPK-MB, CRP, and APTT had statistically significant differences in the groups with previous CVI compared to the groups without CVI. The results of multiple regression analysis indicated a statistically significant positive relationship in the study groups between the development of myocardial infarction and such indicators as CRP, blood glucose, low-density lipoproteins (LDL), previous CVI, as well as a negative relationship with left ventricular ejection fraction and high-density lipoproteins (HDL). The role of these predictors in the development of myocardial infarction was confirmed using ROC analysis.

Conclusion: The results of our study indicated a relationship between previous coronavirus infection and an increased risk of coronary artery restenosis in patients with previous myocardial revascularization.

Infective endocarditis (IE) is characterized by the difficulty of diagnosis, treatment and risk assessment of an unfavorable prognosis. Currently there are no approved scales and calculators for the risk of complications and death that help the practitioner make decisions, especially in patients with isolated right-sided IE. For right-sided IE, the timing of successful surgical treatment remains uncertain. Previously developed risk calculators (Italian Rizzi calculator and French Hubert) are poorly validated in a wide population of patients with IE, especially for right-sided IE. One of the required parameters of calculators is the determination of etiological affiliation. However, with negative results of microbiological studies reaching 56-83 %, this parameter becomes uninformative. Moreover, existing risk assessment tools do not take into account the activity of the disease (including laboratory activity), which intuitively is an important guideline for every doctor in decision-making. At the moment, there is a great need for the introduction of molecular biological methods to improve the quality of etiological diagnosis and in-depth study of possible biomarkers from simple (neutrophil/lymphocytic, platelet/lymphocytic and systemic immuno-inflammatory index) to more complex (neutrophil extracellular traps, cytokine profile). We present a clinical case of a young patient with acute tricuspid valve IE with giant vegetation (28 mm), complicated by severe valvular insufficiency without signs of heart failure, recurrent embolic syndrome in the pulmonary artery system with the formation of pulmonary hypertension, determining indications for cardiac surgical treatment. The etiological affiliation of IE to Staphylococcus aureus was established only by PCR. The urgent timing of intervention was determined based on an increase in new markers — neutrophil/lymphocytic index ≥20.0, systemic immuno-inflammatory index ≥2314.0 and neutrophil extracellular traps ≥14.2, indicating an extremely high risk of death. A fundamental pathohistological study of the tissue material revealed a low content of intact CD86+ proinflammatory macrophages, probably associated with their excessive destruction and uncontrolled release of copious amounts of proinflammatory cytokines, which led to rapid and severe damage to the tricuspid valve. Thus, modern management of patients with IE should be multiplex using current methods of etiological and imaging diagnostics, and aimed at early detection of patients at adverse risk for a timely differentiated approach to conservative or cardiac surgical treatment tactics.

Dercum disease, also known as painful lipomatosis, neurolipomatosis, Ander’s syndrome, is a rare illness. The main clinical manifestation of this disease is the presence of painful formations of subcutaneous tissue, localized in various parts of the body: on the limbs, trunk, buttocks. Possible etiological factors include genetic mutations, the presence of abnormal cellular proteins, endocrine disorders, changes in the nervous system. This disease is more common among women over 35 years old. Cases of Dercum disease in children and adolescents are rare. Patients with this disease are often overweight. There are 4 types of Dercum disease: generalized diffuse, generalized nodular, localized nodular, juxta-articular forms. In some cases, acute inflammatory markers increase: the erythrocyte sedimentation rate, C-reactive protein. A high level of tumor necrosis factor-α with a decrease over time was also noted in the presented clinical case, it requires further study of the prognostic capabilities as a marker of disease activity. Histological examination of subcutaneous elements did not reveal specific changes (the morphological picture corresponds to lipoma). Various methods of therapy are discussed in the literature, including liposuction, massage. Non-steroidal anti-inflammatory drugs, glucocorticoids, methotrexate also may be used. The clinical case presents a 42-year-old female patient with complaints of the presence of painful local nodular skin lesions of various sizes on the upper and lower extremities. We describe the early diagnosis of Dercum disease with differential diagnosis with panniculitis of other etiologies and the achievement of stable remission against the background of methotrexate therapy.

Hyperosmolar hyperglycemic state is an acute complication of diabetes mellitus, the mortality rate of which reaches 50 %. One of the reasons for the unfavorable outcome is untimely diagnosis, which is often due to insufficient awareness of doctors regarding the features of clinical and laboratory manifestations of this diabetic complication. Hyperosmolar state often develops in older patients with polymorbidity, and neurological symptoms predominate in the clinical picture, which also complicates diagnosis and causes diagnostic errors. The article presents a clinical case of hyperosmolar hyperglycemic state, the diagnosis of which caused difficulties at all stages, including postmortem pathological examination. Initially, acute cerebrovascular accident was assumed, then the patient’s severe condition was associated with acute myocardial infarction, and based on the results of the pathological examination, a conclusion was made about sepsis and septic shock. Review of the patient’s medical history showed that the most probable diagnosis was hyperosmolar state, which developed as a result of decompensation of diabetes mellitus against the background of the inflammatory process. Severe dehydration of the patient, as the cause of her soporous state, was confirmed by the data of examination and laboratory and instrumental examination: dry skin and mucous membranes, small amount of urine, signs of blood thickening and prerenal acute renal failure. At the same time, the absence of obvious focal neurological disorders, clinically significant changes in the cardiovascular system, fever and hemodynamic disturbances did not allow, in our opinion, to associate the patient’s severe condition with acute cerebrovascular accident, myocardial infarction or septic shock. Dehydration was complicated by the development of disseminated vascular coagulation syndrome, gastrointestinal bleeding and hemorrhagic shock with a fatal outcome. This clinical case demonstrates that in differential diagnostics of diseases a more reliable approach is the analysis of the clinical picture from the point of view of the pathogenesis of disorders. Analysis of such clinical situations can serve as an aid for doctors in diagnosing hyperosmolar state.