The widespread use of GIP and/or GLP-1 receptor agonists for the treatment of type 2 diabetes mellitus and obesity has introduced new challenges in the perioperative period. These agents induce delayed gastric emptying, rendering traditional preoperative fasting protocols less effective and significantly increasing the risk of pulmonary aspiration of residual gastric contents. Suppression of the migrating motor complex leads to the retention of solids and liquids in the stomach far beyond standard physiological durations. Current recommendations regarding the pre-procedural prophylactic withdrawal of these drugs carry the risk of losing glycemic and metabolic control, as the long half-life of weekly formulations would require a treatment hiatus exceeding 4–5 weeks. Based on a literature review and clinical experience, this article proposes a novel perioperative management approach that avoids interrupting targeted incretin mimetic therapy. This strategy is based on preliminary aspiration risk stratification: Low-risk group (patients on stable, asymptomatic therapy): Validates a preventive combined preparation consisting of a 24-hour clear liquid diet in conjunction with prophylactic prokinetics to actively overcome gastric atony and stimulate emptying. High-risk group (presence of dyspepsia, initiation or dose escalation phase, morbid obesity): This pharmacological and dietary preparation is mandatory and must be supplemented by Point-of-Care Ultrasound (POCUS) of the stomach on the day of the intervention. The implementation of this dual strategy – pharmacological/dietary motility correction and ultrasound monitoring – reliably minimizes delayed gastric emptying and the risk of bronchopulmonary aspiration without depriving patients of the positive effects of weight-loss and cardiometabolic therapy.

Type 2 diabetes mellitus (T2DM) is a chronic disease that is reaching epidemic proportions worldwide. The main contributors to the increasing prevalence of T2DM are urbanization, population aging, and decreased physical activity, leading to the climbing rates of obesity. Currently, obesity and T2DM remain key causes of comorbid pathology and contribute to rising mortality rates globally. This article explores the role of adipose tissue and insulin resistance in the T2DM pathogenesis. Particular attention is paid to the importance of the enteroinsular axis, as well as incretin hormones which hold a leading place in the regulation of carbohydrate metabolism. Among these, glucagon-like peptide-1 (GLP-1), a hormone with both pancreatic and extrapancreatic effects, is the most studied one. A deeper understanding of disease mechanisms has made it possible to expand. the range of hypoglycemic medications. The multifaceted pathogenesis of T2DM requires an integrated effect on the variety of pathogenetic mechanisms of the disease development. This multitargeted approach makes it possible to achieve a more pronounced and sustained glucose-lowering effect and maintain glycemic control at different stages of disease progression. At the same time, the emphasis is made on the importance of personalized drug therapy. Current guidelines recommend considering GLP-1 receptor agonists (GLP-1RA) as the first-line agents for the initial therapy of T2DM, including the option of their combined use with other hypoglycemic agents (HGAs). GLP-1RA have been widely recognized as effective agents in improving cardiovascular disease (CVD) outcomes. This article presents data from clinical trials demonstrating the efficacy, safety, and tolerability of semaglutide. The pharmacological properties and therapeutic benefits of the agent based on the results of studies comparing it with other GLP-1RA and other groups of HGAs are discussed. In addition to discussing semaglutide’s primary action aimed at improving glycemic control and weight loss, additional beneficial effects, such as lowering blood pressure and improving lipid metabolism parameters, are highlighted.

Self-monitoring of blood glucose levels remains an important clinical tool for managing patients with diabetes, and self-monitoring training is included in all structured patient education programs. Early carbohydrate metabolism disorders (impaired fasting glucose, impaired glucose tolerance) also require regular assessment of target achievement for both blood glucose levels and other health parameters. Innovative digital technologies in diabetology, such as portable glucometers with Bluetooth data transfer and a mobile app, and continuous glycemic monitoring systems, provide additional convenience and advantages in maintaining and interpreting patient outpatient glycemic profile data. Digital healthcare innovations in diabetes allow for greater patient engagement in diabetes mellitus, increase their adherence to therapy and overcome the risks of dysglycemia. This review examines the expansion of the horizons of highly effective and affordable health-saving strategies in patients with diabetes mellitus and prediabetes on the example of glucometry with the use of digitalization as an important and integral tool for disease management. Individualization of goals, display of glycemic trends, convenience and multifunctionality of devices with Bluetooth data transmission and a mobile application allow for better adaptation of patients with diabetes. Trends and innovations in glycemic management highlight the importance of glucometer technology and digitalization in improving patient-doctor interactions to achieve glycemic targets and prevent acute and chronic complications of diabetes.

Introduction. Type 2 diabetes mellitus (T2DM) is a chronic endocrine disorder characterized by metabolic disturbances, the etiology and pathogenesis of which have not been fully identified. Recent scientific studies demonstrate a strong association between the oral microbiome (OM) and T2DM. The OM with its extensive species diversity and metabolic profile, contributes to the onset and progression of not only local oral diseases but also systemic metabolic pathologies, including cardiovascular diseases, obesity, T2DM, and related conditions.

Aim. To analyze the contribution of OM, its metabolites, and host genetic factors to the development of T2DM.

Materials and methods. A systematic review of articles and original studies from PubMed, MEDLINE, and eLIBRARY databases for the period 2005–2024 was conducted. Inclusion criteria encompassed full-text peer-reviewed publications in Russian and English containing data on the microbial composition of the oral cavity in T2DM, microbial metabolome, and host genomic variations. Excluded were conference abstracts and materials unrelated to OM in T2DM. The search utilized combinations of keywords: “type 2 diabetes mellitus”, “oral microbiota”, “metagenomic/metabolomic shifts”, “prognostic biomarkers”. The initial search yielded 460 sources. After removing duplicates, applying filters, and assessing relevance, 68 sources remained for in-depth analysis (5 for the introduction, 63 for the discussion).

Conclusion. The reviewed data provide a foundation for innovative diagnostic and therapeutic strategies in primary and secondary prevention of T2DM complications. Metabolomic and metagenomic approaches establish correlations between OM and T2DM onset, enable risk prediction, and facilitate the development of early intervention tools, which is critical for complication prevention.

Introduction. Type 2 diabetes mellitus (T2DM) remains one of the leading medical and social problems, associated with insulin resistance and high cardiometabolic risk. Therapy aimed at overcoming insulin resistance can improve not only carbohydrate but also lipid metabolism, vascular function, and patients’ quality of life.

Aim. To obtain additional data on the efficacy and safety of Subetta as part of combination therapy for T2DM in real-world clinical practice.

Materials and methods. The non – interventional observational program SILA enrolled 889 patients with T2DM (mean age

58.8 years, 63.67% women). In addition to standard glucose – lowering therapy, patients received Subetta according to patient information leaflet. Efficacy was assessed after 12 weeks of therapy based on changes in carbohydrate metabolism parameters, blood pressure, lipid profile, anthropometric measures, triglyceride – glucose (TyG) index, and quality of life (SF-36, VAS). Results and discussion. After 12 weeks of therapy, significant reductions were observed: HbA1c from 7.26% to 6.76% (p < 0.001), and fasting plasma glucose from 7.47 to 6.54 mmol/L (p < 0.001). The target HbA1c level was achieved by 50.84% of patients. Lipid profile improved (total cholesterol from 5.80 to 5.34 mmol/L (p < 0.001), triglycerides from 2.01 to 1.73 mmol/L; p < 0.001), and the TyG index decreased from 7.54 to 5.69. Body weight decreased from 88.85 to 86.58 kg (p < 0.001), together with BMI, waist circumference, and blood pressure. Physical and mental health scores on SF-36 increased from 44.16 to 47.72 (p < 0.001) and from 44.72 to 48.22 (p < 0.001), respectively. Favorable changes in kidney function markers (reduced albumin and creatinine with stable glomerular filtration rate) were recorded. Adverse events were reported in 0.3% of patients; no drug discontinuations occurred.

Conclusions. Adding Subetta to combination therapy for T2DM in real-world clinical practice is associated with improved glycemic control, cardiometabolic parameters, renal function, and quality of life, with a high safety profile.

Persistent primary hyperparathyroidism (PHPT) following parathyroidectomy is most often caused by ectopia of a pathologically altered parathyroid gland (PTG). This condition makes accurate preoperative topographic diagnosis critically important, especially in repeat interventions, which themselves are associated with an increased risk of complications due to scar tissue formation and difficulties in anatomical identification. In the presented clinical case, a 70-year-old patient had persistent biochemical signs of PHPT after the initial surgery. During that intervention, a lesion identified on imaging as a PTG adenoma was removed, but postoperative histology unexpectedly revealed papillary thyroid cancer. This diagnostic dilemma clearly illustrates the morphological similarity of various neck lesions during intraoperative examination and underscores the value of intraoperative histological examination in ambiguous situations. To identify the cause of disease persistence, a comprehensive examination was performed. Repeat scintigraphy with SPECT/CT and multispiral computed tomography (MSCT) allowed for precise localization of the pathological focus. An ectopic adenoma of the right inferior PTG with aberrant migration, corresponding to Type C according to the Perrier classification, was diagnosed and subsequently successfully removed. This case confirms the necessity of a multidisciplinary approach and high oncological vigilance in managing patients with PHPT. It also demonstrates the practical utility of PTG ectopia classifications, which not only systematize anatomical location but also help the surgeon predict the technical complexity of the upcoming intervention, potential risks, and choose the optimal surgical approach.

Introduction. Obesity adversely affects the menstrual cycle (MC) and the onset of pregnancy. One of the ways to treat obesity is to perform bariatric surgery (BS). The most common of these is laparoscopic sleeve gastrectomy (LSG), but its effect on MC has not been sufficiently studied.

Aim. To evaluate MC in obese women of reproductive age after LSG.

Materials and methods. Initially and 12 months after LSG for 47 obese women was calculated body mass index (BMI), HOMA-IR insulin resistance index, plasma anti-muller hormone (AMH) and MC characteristics, determined the duration of obesity, the number of weight loss attempts of more than 10%, the presence of ovarian surgery and burdened heredity by early menopause. The patients were divided into groups depending on their MC before LSG (regular cycle, n = 24; irregular MC (IMC), n = 23), and also stratified by the dynamics of MC after surgery: recovery, preservation or occurrence of disorders for the first time.

Results. BMI decreased in all patients 12 months after LSG, and carbohydrate metabolism improved. 48.9% of patients had irregular MC before surgery, and only 56.5% of cases showed normalization of the menstrual cycle 12 months after surgery. 47.8% of patients had irregular MC after LSG, and 52% of women had irregular MC for the first time after surgery. The presence of irregular MC after LSG was associated with BMI, weight loss dynamics, severity of insulin resistance, and AMH levels. Burdened heredity due to early or premature menopause increased the likelihood of developing irregular MC after LSG.

Conclusions. LSG has an ambiguous effect on MC in obese women. Despite the improvement in body weight and carbohydrate metabolism, 52% of patients with an initially regular cycle had irregular MC for the first time after surgery.

An increased prevalence of malignant neoplasms (MNs) in acromegaly compared to the general population has been demonstrated in many studies. However, the spectrum of MNs and the degree of increased risk vary significantly depending on the study region.

Aim. To compare the frequency and nosological structure of MNs in patients with acromegaly and in the general population of one region of the Russian Federation.

Materials and methods. A retrospective, observational, single-sample, cohort, uncontrolled, non-interventional study. We included patients’ data on 31.12.2009, 31.12.2014, 31.12.2019, and 31.12.2024. We compared the prevalence and types of MNs in the cohort of patients with acromegaly and in the general population of the region.

Results. MNs were observed in 13 (8.0%) patients in 2009, 26 (10.7%) in 2014, 35 (12.2%) in 2019, and 38 (14.5%) in 2024 (p for trend = 0.001). In all analyzed years, the most common MNs in the general population of the Moscow region were breast, skin (except melanoma), uterine body, colon, stomach or prostate. In acromegaly, the general prevalence of MNs was higher compared to the region and increased from 2009 (OR 3.442, 95%CI 1.95; 6.076, p < 0.001) to 2024 (OR 7.255, 95%CI 5.131; 10.25, p < 0.001). The most common types of MNs in acromegaly were thyroid cancer (39–53 times higher than in the general population), colon cancer (8–16 times), uterine cancer (7–8 times), breast cancer (up to 4 times), and pancreatic cancer as highly differentiated neuroendocrine tumors (44–82 times). The remaining types of MNs diagnosed in patients with acromegaly did not exceed population rate.

Conclusion. In the Moscow region, the prevalence of malignant neoplasms associated with acromegaly was higher than the general population and has increased 1.8-fold over the past 15 years. The nosological structure of malignant neoplasms differed from that of the general population, which must be considered at the screening plan for patients with acromegaly.

Introduction. Differential diagnosis of primary and secondary hyperparathyroidism is crucial for determining treatment tactics. Diagnosis directly depends on the assessment of calcemia, for which the determination of total, ionized, and albumin-adjusted calcium is used. However, the diagnostic value of various methods for assessing calcemia remains a subject of debate.

Aim. To compare the effectiveness of calcemia assessment methods in the differential diagnosis of primary and secondary hyperparathyroidism.

Materials and methods. The study evaluated the diagnostic informativeness of various methods for determining serum calcium (total; ionized, estimated by calculation; adjusted for albumin level), taking into account their sensitivity, specificity, and predictive value for diagnosing the normocalcemic variant of PHPT (nPHPT) among patients hospitalized at the Department of Parathyroid Pathology and Mineral Metabolism Disorders of the Federal State Budgetary Institution “National Medical Research Center for Endocrinology named after Academician I.I. Dedov” of the Ministry of Health of Russia from 2018 to 2024. An additional analysis of the clinical and laboratory characteristics of nPHPT compared to patients with secondary hyperparathyroidism (SHPT) was conducted. Statistical analysis was performed using the STATISTICA 12 software package (StatSoft, Inc.). ROC analysis was performed to analyze the diagnostic value of the studied methods.

Results. The frequency of the normocalcemic variant of primary hyperparathyroidism was 6.7%. No significant differences from secondary hyperparathyroidism were found in the main clinical and biochemical parameters. Total and albuminadjusted calcium proved to be the most informative for diagnosis, while ionized calcium, estimated by calculation, showed less value.

Conclusions. For the differential diagnosis of primary and secondary hyperparathyroidism, total and albumin-adjusted calcium levels are of the greatest value and can be considered as priority methods for assessing calcemia in clinical practice.

Nutrition plays a crucial role in maintaining human health across the lifespan. The observed decrease in physical activity among the population and adherence to the Western dietary patterns characterized by a high intake of ultra-processed foods (UPF) with high energy density (HED), but low nutritional value has negatively affected nutritional status in modern humans and led to the widespread deficiencies in dietary fiber, high-quality protein, various micronutrients, and minor bioactive food components. Moreover, a non-rational and unbalanced diet is a recognized factor for the development and progression of a whole range of socially significant chronic non-communicable diseases, including obesity, type 2 diabetes mellitus, hypertension, coronary heart disease, and cancer pathology, which are currently the leading cause of premature mortality among population. Replenishment of nutritional deficiencies and prevention of alimentary-dependent diseases is an important public healthcare objective that can be achieved by using biologically active dietary supplements with proven efficacy and safety. Dietary intervention with advanced nutritional formulas, including Glivanz® and Glivanz® Fiber, is a new approach that help create diets tailored to individual body needs in various clinical settings. As dietary fiber, Glivanz and Glivanz® Fiber contain resistant corn maltodextrin (Fibersol), which offers many potential health benefits for the gastrointestinal tract from motility regulation to gut microbiota modulation. It also has several pleiotropic effects enabling reduction of cardiometabolic risks, including postprandial blood glucose control and lipid metabolism improvement. High protein content should be emphasised as one more advantage of biologically active dietary supplement Glivanse®. Its composition is represented by a blend of milk and vegetable proteins, which ensures a complete set of essential amino acids, optimal digestibility, and the product's biological value.

Aim. To present a pre-specified secondary analysis of the randomized trial and compare the effects of a low-carbohydrate versus a Mediterranean diet on growth factor levels, as well as on lipid profile and ovulatory function in women with PCOS. Materials and methods. Eighty-seven patients with PCOS were randomized to either a low-carbohydrate diet (n = 44) or a Mediterranean diet (n = 43). The research protocol is registered on clinicaltrials.gov (NCT05272657). Fasting serum samples were collected at baseline and after 3 months of the dietary intervention. In this study, we conducted a secondary analysis of changes in anthropometric measures, lipid profile, ovulatory function, and circulating growth factors (EGF, FGF2, FLT3L, PDGF-AA, PDGF-AB/BB, VEGF-α).

Results. Weight loss was comparable between the groups. The Mediterranean diet led to significantly greater reductions in total cholesterol and LDL cholesterol and restored ovulation more frequently. In the analyzed subgroup, the Mediterranean diet reduced FLT3L, FGF2, PDGF-AA, and PDGF-AB/BB levels, whereas the low-carbohydrate diet increased them. Several of these differences remained significant after correction for multiple comparisons.

Conclusion. Despite similar weight loss, the Mediterranean diet was superior to the low-carbohydrate diet regarding lipid profile improvement, restoration of ovulatory function, and modulation of key angiogenesis/fibrosis factors in women with PCOS. These findings point to potential pathogenetic benefits of the Mediterranean diet, which warrant confirmation in larger and longer-term studies.

Obesity is one of the most significant medical and social problems of our time, being the leading preventable cause of global morbidity and premature mortality. According to the results of large-scale epidemiological studies, over the past few decades the prevalence of this condition has taken on the characteristics of a pandemic of non-communicable diseases: the global prevalence of obesity has almost tripled, posing a serious challenge to healthcare systems in the 21st century and resulting in colossal economic losses. The updated dietary guidelines (Dietary Guidelines for Americans) marked the introduction of a fundamentally new visual model of nutrition, based on the concept of prioritising whole foods and strictly limiting ultraprocessed foods, which effectively led to the transformation of the traditional model into an ‘inverted’ pyramid focused on the nutritional density of the diet. In line with the current positions of leading global and domestic professional communities, the basis for successful treatment remains a comprehensive, personalised lifestyle modification, including dietary behaviour correction and regular physical activity. However, the priority use of innovative pharmacological agents – glucagon-like peptide-1 (GLP-1) receptor agonists and dual GLP-1 receptor agonists – is becoming a key driver and innovative breakthrough in modern evidence-based medicine.

The prevalence of obesity is rapidly increasing. Impaired fat metabolism has dangerous consequences: excess adipose tissue is associated with metabolic disorders, cardiovascular diseases, damage to the respiratory and musculoskeletal systems, kidneys, hepatobiliary and gastrointestinal tracts, and even cancer. Unfortunately, many of these diseases are now common among pediatric patients. Obesity is a disease that requires treatment. Often, the problem of excess weight begins in childhood and continues throughout life, so the increasing prevalence of obesity among children and adolescents is particularly alarming. Obesity is primarily caused by an excess of energy intake over energy expenditure. Many factors influence the risk of obesity, including biological, behavioral, environmental, socioeconomic, cultural, geographical, and psychological factors. Contributing factors include comorbidities, the use of certain medications, and changes in the gut microbiota. Rapid urbanization and globalization of society exacerbate the consumption of high-calorie foods and a sedentary lifestyle, fostering an environment conducive to the development of obesity. However, not everyone living in such conditions will become obese. There are a number of modifiable risk factors that, if addressed, can successfully manage body weight. Improving the knowledge of both physicians and patients can significantly facilitate the fight against such a complex disease as obesity. This article, intended for pediatricians, outlines the risk factors for obesity in children and adolescents. The review includes the results of over 80 systematic reviews, meta-analyses, and clinical studies, selected from Google Scholar, PubMed, and Web of Science using the keywords “obesity”, “overweight”, “body mass index”, “risk factors”, “nutrition”, and “microbiota”. Duplicates and publications describing clinical cases and off-topic issues were excluded.

Introduction. Thyroid diseases are the most common endocrine pathology. Neuregulin-4 (NRG4) is an adipokine secreted by brown adipose tissue, with reduced levels in non-alcoholic fatty liver disease (NAFLD). The influence of thyroid status on NRG4 has been insufficiently studied.

Aim. To investigate NRG4 levels in men with NAFLD and different thyroid status.

Materials and methods. This cross-sectional study included men aged 32–49 years with NAFLD (n = 70), divided by thyroid status: hypothyroidism (n = 25), subclinical hyperthyroidism (n = 20), and normothyroidism (n = 25). The control group consisted of 26 men without thyroid or liver pathology. All participants underwent point shear wave elastography (pSWE) of the liver.

Results. The NRG4 level in the overall NAFLD group was significantly lower than in controls: 2.1 (1.6; 3.8) ng/ml vs. 2.95 (2.92; 2.96) ng/ml (p = 0.041). Stratification revealed multidirectional dynamics: decreased NRG4 in normo- (1.6 ng/ml) and hypothyroidism (2.2 ng/ml), and increased levels in subclinical hyperthyroidism (4.0 ng/ml). In hypothyroidism, NRG4 correlated with liver stiffness (r = 0.406); in hyperthyroidism, it correlated with body mass index (r = -0.391).

Conclusions. In patients with NAFLD and hypothyroidism, NRG4 levels are lower than in those with hyperthyroidism. Hypothyroidism may exacerbate NAFLD progression by suppressing the protective adipokine NRG4. The paradoxical increase in NRG4 in subclinical hyperthyroidism, despite high liver stiffness, is likely a compensatory response to metabolic stress.

Introduction. Among the most significant complications of diabetes mellitus (DM) is cardiovascular autonomic neuropathy (CAN) that is a serious but sometimes poorly recognised complication.

Аim. To evaluate the prevalence of cardiovascular autonomic neuropathy (CAN) and its role in the development of chronic heart failure (CHF), chronic kidney disease (CKD) and atherosclerotic cardiovascular diseases (ACCD) in patients with type 2 diabetes mellitus (T2DM).

Materials and methods. 80 patients with DM2 were examined. To diagnose CAN, each patient underwent a set of functional tests (Table 1), the patients were divided into 2 groups: with a confirmed diagnosis of CAN and without CAN. Clinical and anamnestic, laboratory data and a set of instrumental studies for the diagnosis of cardiorenal complications of diabetes were evaluated. A comparison of the prevalence, as well as the risk ratio for the main complications of type 2 diabetes has been carried out.

Results. In the CAN group, heart failure (HF) was diagnosed significantly more frequently, occurring in 87.9% of cases compared to 59.5% in the group without CAN (p < 0.05). It was established that CAN correlates primarily with the development of heart failure with preserved ejection fraction (HFpEF): 78.8% vs. 34.0% (p < 0.05). Differences in the prevalence of chronic kidney disease and atrial fibrillation showed borderline significance. The presence of CAN increases the risk of developing HF nearly fivefold (RR = 4.92; p = 0.001), and the risk of HFpEF more than fivefold (RR = 5.50; 95% CI: 4.16–7.92; p = 0.0001).

Conclusion. In the present study, almost every second patient with DM2 had an undiagnosed CAN. The presence of CAN increased the chances of developing CHF by more than 5 times, while there was no significant effect on the risk of developing CHF with reduced and moderately reduced LV (CHF/nFV). Despite the growing understanding of the role of CAN, its prognostic significance and mechanisms in the development of specific cardiorenal complications remain the subject of active research.

This article addresses the current issues in the treatment of arterial hypertension (AH) in clinical practice. Despite the availability of effective antihypertensive agents, most patients with AH fail to achieve the blood pressure (BP) targets. This situation becomes even more important due to the growing awareness of the need to achieve lower BP readings in a wide range of patients.

This article explores the current evidence supporting the effectiveness of the approach to lowering blood pressure levels and, what can be viewed as being just as important, maintaining these levels over a long period. New data on the role of pulse wave velocity reduction as a factor for assessing the efficacy of antihypertensive therapy are presented. In particular, various components of the pulse wave velocity which change differently with a decrease in blood pressure are discussed. The authors consider the recently reported results from the meta-analysis of randomized clinical trials, which was conducted to find answers to a number of essential questions relating to the management of hypertension in patients with chronic kidney disease (CKD), specifically, whether hypertension treatment strategies in patients with CKD should differ from those in patients without CKD. The current approaches to the choice of optimal antihypertensive therapy determined by new treatment goals for patients with hypertension are reviewed. The advantages of using azilsartan in combination with amlodipine or chlorthalidone, as well as the advantages of angiotensin II receptor blockers in antihypertensive therapy compared to angiotensin-converting enzyme inhibitors are highlighted.

Introduction. Obstructive sleep apnea syndrome (OSA) is a common cause of hypertension, driven by common pathogenetic mechanisms, primarily sympathetic hypertension. The use of beta-blockers (BB) is pathogenetically justified; however, the efficacy and safety of this treatment strategy require clarification.

Aim. To evaluate the efficacy and safety of BB in combination antihypertensive therapy in patients with OSA.

Materials and methods. The study included 109 men with hypertension (HTN), obesity, and OSA (apnea/hypopnea index > 15/hour). Participants had no baseline structural heart disease, diabetes, coronary artery disease, atherosclerosis of any location, or atrial fibrillation. All participants were divided into groups based on the chosen treatment strategy – beta-blocker therapy and continuous positive airway pressure therapy (CPAP). Following a three-year follow-up period, biochemical marker levels were re-evaluated, and the incidence of adverse clinical events was compared.

Results. A statistically significant increase in high-density lipoprotein (HDL) levels and a decrease in the METS-IR insulin resistance index were found in the groups receiving beta-blockers, while a statistically significant decrease in triglyceride levels was observed with a combination of beta-blockers and CPAP therapy. In the groups of patients not receiving beta-blockers, an increase in atherogenic fractions of total cholesterol and non-HDL cholesterol was noted. The incidence of adverse clinical outcomes did not differ significantly between the groups with different treatment strategies; however, the use of beta-blockers allowed a greater number of participants to achieve target blood pressure levels.

Conclusions. The study results demonstrate the high efficacy and safety of using beta-blockers as part of combination antihypertensive drug therapy in obese men with hypertension associated with OSA.

Aim. To assess the frequency of obstructive coronary artery disease (CAD) and coronary calcium score (CCS) measured by coronary computed tomography angiography (CTCA) in patients with IS depending on the presence of myocardial injury (MI), the association between clinical and laboratory parameters and the absence of coronary calcification.

Materials and methods. In a prospective registry study, 50 patients (median age 60 (52; 66) years) with confirmed IS underwent CTCA. HsTn-I was obtained on admission and repeated within 48 hours.

Results. CTCA did not detect significant coronary stenoses in 8 (44.4%) of 18 patients with acute MI, in 3 (33.3%) of 9 patients with chronic MI, and in 15 (65.3%) of 23 patients without MI. In patients with and without MI a CCS was comparable: 143 (0; 266) vs 68 (4; 205), respectively (p = 0.662). There was no statistically significant difference between hsTn levels in CCS categories of CAD risk. In multivariate regression analysis in patients with IS a change (D) in hsTn with a cutoff value of less than -2 ng/L increased odds ratio for absence of coronary calcification by 5.931 times (95% confidence interval 1.129–31.150; p = 0.035).

Conclusions. About half of patients with IS and acute MI, 1/3 of patients with chronic MI, and almost 2/3 of patients without MI did not have obstructive CAD. Absolute change in hsTn was independently associated with the absence of coronary calcification in patients with IS.

Aim. To conduct an examination of adolescent children and young people with syncope and identify the changes of laboratory and instrumental indicators of the functioning of the cardiovascular system.

Materials and methods. After a survey of 1685 people aged 6–22 years (average age 14 ± 4.4), we selected 519 (30.8%): 112 (6.6%) with syncope and 397 (23.5%) with presyncope. All of them were examined with measurements of height, weight, blood pressure and ECG in the supine position, ECHO with calculation of the myocardial mass index, ambulatory monitoring (AM), level of K, Mg, Ca, Hb, ferritin.

Results. The prevalence of syncope at the age of 6–22 years was 6.6%. There were significantly lower blood pressure and heart rate values by AM in the group with syncope, higher values of the QT interval on the ECG. The direct relationship was revealed between the duration of the QT interval and wall thickness LV (r = 0.322, p < 0.001), IVSd (r = 0.334, p < 0.001) and IMMLV (r = 0.454, p < 0.001) and a negative relationship with the level of Ca and Mg (r = –0.341–0.354, p < 0.001).

Conclusions. The prevalence of syncope among young people aged 6–22 years is 6.6%. Young people with syncope are characterized by lower blood pressure and heart rate according to the results of AM and a longer duration of the QT interval on the ECG. A direct relationship was noted between QT interval and the size of the LVPWd, the IVSd and the IMMLV, and a negative relationship with the level of Ca and Mg.

Introduction. Atrial fibrillation (AF) is an independent risk factor for cognitive decline (CD). However, the role of iron deficiency (ID) and anemia as modifiable factors exacerbating cognitive impairment in this issue remains understudied.

Aim. To assess the impact of anemia/ID on the condition of cognitive functions young and middle age patients with AF. Materials and methods. This cross-sectional study included 45 patients with AF (median age 53.2 [50.4; 57.2] years), divided into two groups: with anemia and/or ID (n = 23) and without (n = 22). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Trail Making Test (Parts A & B), Verbal Fluency Test, Word-List Recall, Stroop Test, Digit Span Test, and Digit Symbol Substitution Test (DSST). Anxiety and depression levels were evaluated using the Beck Anxiety Inventory (BAI) and Hamilton Depression Rating Scale (HDRS).

Results. Compared to patients without anemia/ID, patients with AF and anemia/ID demonstrated significantly lower total scores on the MoCA (26 [25; 27] vs 28 [27; 28.5] points, p < 0.001) and MMSE (26 [25; 26] vs 28 [28; 29] points, p < 0.001). They also showed reduced performance in immediate word recall (4 [4; 5] vs 5 [5; 5.3] words, p = 0.032), delayed recall (3 [3; 3.3] vs 4 [4; 5] words, p < 0.001), and the letter fluency test (13 [12.8; 14] vs 14 [13; 15] words, p = 0.013). Psychomotor speed was slower on the DSST (46 [41; 50] vs 55 [44.8; 65] points, p = 0.011), attention was worse on the Digit Span Test (4 [4; 4.3] vs 5 [4.8; 5.3] points, p = 0.005), and execution time was longer for Trail Making Test Part A (61.5 [57.8; 63.8] vs 50 [45; 57.3] s, p < 0.001) and Part B (79.5 [74; 92] vs 69 [64; 77] s, p < 0.001).

Conclusions. Anemia/ID in young and middle-aged patients with AF is associated with multiple cognitive deficits, which justifies the need for screening of iron metabolism and hemoglobin levels in this patient population.

Introduction. Atrial fibrillation (AF) is a burden of aging and a common heart rhythm disorder in adults. Predictors of AF remain poorly understood, and arrhythmia is often first diagnosed during or after a cardiovascular event, despite improved diagnostic capabilities. This underscores the relevance of the search for new predictors of cardiovascular risk, including genetic ones.

Aim. To analyze the association between rs35089892 (CAMK2B) and incident AF in subjects aged 45–69 years at the time of inclusion in the study over a13-year follow-up of the cohort.

Materials and methods. The study object was the cohort of Novosibirsk inhabitants, the HAPIEE project (n = 9,360; baseline examination 2003–2005), follow-up period to 01/31/2018 was analyzed. Among participants of the cohort with incident AF (n = 473), a “case” group (n = 65; 45% of men) was selected. The “control” group (n = 65) – individuals without arrhythmia, stratified by sex and age. AF was determined by ECG or documented AF cases. Genotyping of rs35089892 (CAMK2B) was performed using the polymerase chain reaction. Statistical data processing was carried out by SPSS.

Results. The carriage of TT genotype rs35089892 was inversely associated with the risk of incident AF (p = 0.003) and the relationship was realized due to the contribution of women (p = 0.027). In the AF group, accumulation of the CT genotype was observed (49.2% versus 35.4% in the control). Men with the CT genotype and AF had higher systolic blood pressure levels and were less likely to suffer from diabetes mellitus compared to controls. The risk of developing AF in carriers of the T allele was reduced, without statistical significance, and the association changed direction to positive in carriers of the CT genotype (p = 0.063) compared with homozygous CC or TT.

Conclusion. The association between AF and CAMK2B gene at the population level has not been described in the literature, and our results indicate the potential for further research on the rs35089892 locus.

The coexistence of atrial fibrillation and coronary artery disease is an adverse prognostic factor increasing the risk of prognosis determining events, including thrombosis/embolism at any location, bleeding, and ultimately death. In many cases, these risks are associated with multi-agent antithrombotic therapy, which includes (at least in the early stages of treatment) the concomitant use of an anticoagulant and two antiplatelet agents such as aspirin and a P2Y12 receptor blocker. The results of key studies of multi-agent antithrombotic therapy made it possible to develop a number of “universal” guidelines aimed primarily at reducing the risk of bleeding in this patient population. The guidelines cover the use of radial arterial (RA) access for percutaneous coronary intervention (PCI), early discontinuation of aspirin, and the preferred use of clopidogrel as a P2Y12 receptor antagonist. As for anticoagulants, the guidelines place clear focus on prescribing “full doses” of direct oral anticoagulants instead of warfarin (unless there is a direct indication for the latter). The review discusses in details issues of the choice of the most preferred oral anticoagulant in terms of its efficacy and safety, including as part of multi-agent antithrombotic therapy. Particular focus has been placed on apixaban, its use and benefits in various patient populations, including those with invasive or conservative treatment strategies, the elderly, and patients with a history of stroke and chronic kidney disease. An indirect comparison of randomized trial results and an analysis of real-world data (RWD) convincingly demonstrate the more favourable safety profile of apixaban compared to rivaroxaban and dabigatran. Apixaban is also considered a preferable choice for geriatric and advanced age patients as its benefits with regards to bleeding complications in this age group are maximal, and its efficacy is not inferior to that in younger patients.

Introduction. Hyperphosphatemia significantly increases the risk of developing cardiovascular pathology, as well as the risk of mortality. In regulating phosphate levels, maintaining a phosphate-restricted diet, adequate dialysis in patients on renal replacement therapy, and the use of phosphate-binding drugs play an important role. The pleiotropic effects of phosphate binders, in particular sevelamer, are known: in addition to reducing serum phosphate levels, they also improve endothelial function, reduce the progression of vascular calcification, and reduce the level of FGF-23, the high level of which is associated with left ventricular myocardial hypertrophy (LVH). Currently, extensive research is being conducted to study the post-transcriptional regulation of the genome, in particular microRNAs. microRNAs are small non-coding RNAs involved in regulating the functioning of both healthy and damaged cells. Changes in their expression have been described in many diseases.

Aim. To determine statistically significant associations between microRNA-21, microRNA-126, and microRNA-210 and calciumphosphorus metabolism parameters, FGF-23, and heart remodeling parameters, and to evaluate the effect of phosphate-binding therapy on these parameters.

Materials and methods. The study included 75 patients with CKD G5(D) on renal replacement therapy (hemodialysis – 53 patients and peritoneal dialysis – 22 patients). The control group consisted of 28 healthy volunteers. All patients underwent determination of total calcium, inorganic phosphorus, alkaline phosphatase, parathyroid hormone, FGF-23 in the blood serum by enzyme-linked immunosorbent assay (ELISA), and the level of expression of microRNA-21, microRNA-126 and microRNA-210 in blood plasma by real-time polymerase chain reaction. Instrumental studies included echocardiography. A separate group of patients was identified who received treatment with phosphate binders for > 1 month: totally 43 patients, and 22 of them received sevelamer carbonate at an average dosage of 4800 mg/day.

Results. Differences were noted in the level of FGF-23 in the blood serum of patients on hemodialysis and peritoneal dialysis: in the group of patients on hemodialysis, the concentration of FGF-23 was higher [30.4 [15.3; 69.81]; 15.3 [1.86; 56.8]; p = 0.022]. The level of FGF-23 in the blood serum significantly correlated with dialysis vintage, the values of creatinine, urea, sodium, glucose, total protein, inorganic phosphorus, PTH and alkaline phosphatase activity (p < 0.05). A direct correlations was found between serum miR-126 and miR-210 and the level of FGF-23 (rs = -0,42; p = 0,04 и rs = 0,31; p = 0,05, respectively). In patients with LVH the level of FGF-23 was significantly higher. In patients receiving sevelamer carbonate the incidence of LVH, as well as levels of FGF-23 (12.4 ± 5.9) was lower, in contrast to the group receiving other phosphate binders (23 ± 7.3; p = 0.003) and PTH (110 ± 27 ng/ml), in the group not receiving the drug – 340 ± 15; p = 0.01. The 12-month treatment with phosphate-binders significantly increase the expression of proangiogenic microRNA-126 (p = 0.002).

Conclusions. The use of phosphate binders, in particular sevelamer carbonate, associated with lower levels of blood phosphorus, FGF-23, PTH and higher levels of expression of proangiogenic microRNA-126.

Introduction. Chronic kidney disease (CKD) and acute myocardial infarction (AMI) form a comorbid pair that mutually aggravates the course and prognosis of each condition. Patients with CKD have a significantly increased risk of cardiovascular events, while AMI exacerbates renal dysfunction.

Aim. To assess the relationship between the severity of cardiac damage and the progression of chronic kidney disease in the post-infarction period.

Materials and methods. We analyzed data from 100 post-MI patients with a one-year follow-up. Inclusion criteria were: age 18 to 89 years and a confirmed MI diagnosis. Cardiac and renal parameters were recorded for all patients. Statistical analysis was performed using correlation methods.

Results. Chronic kidney disease was diagnosed in 61% of the patients. A significant correlation was found between CKD severity and the cumulative cardiac event score (number of myocardial infarctions and percutaneous coronary interventions (PCI)). Each PCI was associated with a 42.6% increased likelihood of developing CKD stages C3a-C4, and each myocardial infarction with a 38.2% increase. A strong positive correlation was observed between the number of PCIs and the stage of chronic heart failure, and an inverse correlation with left ventricular ejection fraction. During the one-year follow-up, a significant increase in serum creatinine and microalbuminuria levels was recorded.

Conclusions. This study on the relationship between chronic heart failure and CKD after myocardial infarction demonstrated a strong association between the degree of cardiac impairment and worsening kidney function. The cumulative cardiac event score showed a particularly strong correlation with CKD stage. Each episode of coronary pathology significantly increased the risk of CKD onset and progression, reflected in a marked increase in serum creatinine and urinary albumin (albuminuria) levels over the one-year observation period.

Arterial hypertension (AH) remains a leading risk factor for cardiovascular complications and cognitive impairment. Effective control of blood pressure (BP) significantly reduces the risk of stroke and coronary artery disease (CAD). However, in real-world clinical practice, achieving target BP levels is often complicated by comorbidities, poor treatment adherence, and neglect of the circadian BP profile, particularly morning BP surges, which are an independent predictor of cardiovascular events. Among antihypertensive drugs, angiotensin II receptor blockers (ARBs) hold a special place due to their proven cerebroprotective effects. Candesartan, one of the most extensively studied representatives of this class, not only effectively lowers BP but also slows the progression of cognitive impairment and significantly reduces the risk of stroke. The presented clinical case demonstrates the potential for treatment optimization in a patient with long-term uncontrolled AH, CAD, obesity, and established cognitive impairment. Given the presence of morning BP surges and cognitive dysfunction, the patient was prescribed candesartan 16 mg/day in combination with bisoprolol, indapamide, and atorvastatin. For secondary prevention of thrombotic complications, acetylsalicylic acid (ASA) combined with magnesium hydroxide was chosen, which preserves the high bioavailability of the immediate-release ASA formulation while simultaneously providing gastric mucosal protection. After 9 months of therapy, target BP levels were achieved, morning BP surges were eliminated, and improvements in cognitive function and regression of left ventricular hypertrophy were observed. Thus, candesartan, due to its cerebroprotective properties and ultra-long duration of action, is the drug of choice in comorbid patients with AH and cognitive impairment. The combination of ASA with magnesium hydroxide provides an optimal balance of antiplatelet efficacy and gastroprotection.

Erectile dysfunction (ED) is a common problem among the male population over 40 years old. Arterial hypertension, dyslipidemia and other cardiovascular diseases (CVDs), as well as some of the medications which are used to treat CVDs can affect erectile function (EF). This article discusses current data about cardiovascular drugs effect on EF and analyzes scientific literature from the following scientific databases: PubMed, ScienceDirect, and eLIBRARY.RU. Angiotensin II receptor blockers have a positive effect on EF. ED, as one of the possible side effects, can be observed during treatment by most beta-blockers (with the exception of nebivolol), diuretics, and non-selective mineralocorticoid receptor antagonists. There is no convincing evidence of a negative effect of angiotensin-converting enzyme inhibitors, calcium channel blockers, selective mineralocorticoid receptor antagonists, and metoprolol on EF. The data of the effect of statin therapy on EF is contradictory. There is a limited number of studies about interaction between angiotensin receptors, neprilysin inhibitors and EF. In many studies subjective methods of EF assessment are used. CVDs and ED have common risk factors and pathogenic mechanisms. Large-scale biobank studies using Mendelian randomization show that ED is more strongly associated with the presence of CVDs rather than with the medications. To clarify CVD drugs effects on EF it is necessary to conduct studies with objective assessment of EF using nighttime penile tumescence monitoring. Knowledge of the characteristics of CVD drugs allows doctors to provide patient with an individualized therapy without adverse events, and ensures a high level of patient adherence to treatment.

Introduction. Chronic kidney disease (CKD) is a widespread, non-communicable chronic condition that leads to a significant deterioration in quality of life and high mortality among patients. Hyperphosphatemia is an independent factor in increasing all-cause and cardiovascular mortality at all stages of CKD.

Aim. To comparatively evaluate the efficacy of calcium-free phosphate binders (sevelamer carbonate and beta-iron(III) oxyhydroxide complex of sucrose and starch) in patients receiving hemodialysis.

Materials and methods. A retrospective analysis of 94 medical records of patients with end-stage CKD receiving renal replacement therapy was conducted. Inclusion criteria: Patients aged 18 to 85 years with end-stage CKD, undergoing hemodialysis for 12 months and receiving phosphate binders.

Results. In the total group of patients (94 people), statistically significant changes in phosphorus levels were observed over the course of the year-long observation period (p = 0.001). In the first group of patients taking beta-iron (III) sucrose oxyhydroxide starch complex, a statistically significant decrease in phosphorus levels over time (p = 0.046) (Friedman test used). In the second group of patients receiving sevelamer carbonate, a statistically significant change was also observed (p < 0.001) (Friedman test used). When assessing the additional effects of phosphate binders, statistically significant changes were found across the two study drug groups: increased blood albumin levels (p < 0.001) and increased transferrin levels (p < 0.001). Statistically significant changes in cholesterol reduction were found in the sevelamer carbonate group (p = 0.044). The Friedman test was used in the assessments. No statistically significant changes were found in C-reactive protein or ferritin levels in the two study groups.

Conclusion. Our studies of the effectiveness of phosphate-binding therapy showed that in both groups there were positive changes in the normalization of phosphorus levels in the blood throughout the entire period and were statistically significant in both comparison groups.

Venous thromboembolic events (VTE) can occur at any time in life, but the incidence of VTE increases with age. A progressive increase in the annual incidence of both deep vein thrombosis (DVT) and pulmonary embolism (PE), both individually and cases of VTE in the aggregate are reported after age 50 years. Patients with multiple clinical risk factors for both thrombotic and/or ischemic events, as well as bleeding, are one of the most challenging categories in real-world clinical practice. The choice of the optimal antithrombotic therapy volume is often not based on the established algorithms and approved guidelines. This review examines the features of the anticoagulant therapy for venous thrombosis occurred in patients with concomitant cardiovascular diseases, especially in atrial fibrillation, coronary heart disease, and hypertension. To assess the current status of the issue, we analysed published literature from the PubMed/MEDLINE and eLIBRARY.RU databases, as well as clinical guidelines of the European Society of Cardiology, the European Society for Vascular Surgery, the American Heart Association, the American College of Cardiology, and national clinical guidelines on the management of deep vein thrombosis, atrial fibrillation, and coronary heart disease. This review discusses the nuances of choosing a treatment regimen, taking into account not only the clinical features of the incident venous events, but also the cardiac indications for the use of anticoagulants and/or antiplatelet agents. Options for the optimal duration of anticoagulation and anticoagulant agent dosages including those used when planning the prolonged therapy with a good balance between risks and benefits are considered. We also evaluated the clinical feasibility and risk of hemorrhagic complications associated with the combined use of anticoagulants and antiplatelet agents in patients with cardiac multimorbidity.

Introduction. A sedentary lifestyle is considered an independent risk factor associated with cardiovascular disease morbidity and mortality.

Aim. To assess the relationship between the level of physical activity (PA) and indicators of total peripheral vascular resistance (TPVR) in normal-weight and overweight young individuals.

Materials and methods. The study included 79 patients aged 18–45 with no history of cardiovascular disease: 33 overweight and 46 normal-weight. In addition to standard data, we assessed TPVR using the APKO-8-RIC-M analyzer and PA using the IPAQ questionnaire. Statistical analysis was performed using the Student’s t-test for independent samples, the Pearson correlation coefficient (r), and linear regression.

Results. There were no significant differences in TPVR and PA levels between the groups. When analyzing the indicators depending on patients’ sex, no significant differences were found in TPVR (p = 0.109) and IPAQ scores (p = 0.956). In individuals with normal body weight, the level of physical activity was negatively correlated with age (r = -0.302, p = 0.041), total cholesterol (r = -0.352, p = 0.017) and glucose (r = -0.329, p = 0.026), but did not correlate with TPVR. In the overweight group, no relationships with age and biochemical parameters were found, but an inverse correlation was observed between IPAQ and TPVR (r = -0.385, p = 0.027). Linear regression showed a significant relationship between TPVR and physical activity (p = 0.027), which explained 14.9% of the variance in TPVR.

Conclusion. A low level of physical activity might have a negative impact on the functional state of the cardiovascular system of young overweight individuals, regardless of its impact on body weight and biochemical parameters.

Introduction. Type 2 diabetes mellitus (T2DM) in the elderly is characterized by a high prevalence of geriatric syndromes (GS) and polypharmacy, which increases patient vulnerability. Therapy with sulfonylureas (SU) is associated with an increased risk of hypoglycemia, especially in older adults. Finding approaches to comprehensive outpatient support for these patients is relevant. Aim. To analyze the initial geriatric and clinical-metabolic status of a cohort of elderly patients with T2DM to substantiate an outpatient monitoring program aimed at correcting GS and optimizing therapy.

Materials and methods. A cross-sectional study was conducted involving 40 T2DM patients (30 women, 10 men) aged ≥ 65 years receiving SU. All underwent comprehensive geriatric assessment (SPPB, dynamometry, Barthel and Lawton scales, MMSE, MoCA, GDS-15, Insomnia Severity Index), evaluation of clinical-metabolic parameters, fall risk, polypharmacy, and social activity.

Results. The mean age was 72.3 ± 4.6 years, T2DM duration was 12 [8.0; 17.5] years, and HbA1c was 7.4 ± 1.1%. Polypharmacy was detected in 90% of patients, with a median number of drugs of 7 [5; 8]. Hypoglycemia history was reported by 45%, and 50% were unaware of its management. Prefrailty/frailty by SPPB was found in 40%, low muscle strength in 30%, falls in 30%, and home fall risk factors in 95%. Mild cognitive impairment by MoCA was detected in 42.5% (by MMSE – in 25%). Social activity was preserved in most (80%). Conclusions. A high prevalence of GS, polypharmacy, and poor awareness of hypoglycemia was revealed in elderly T2DM patients on SU therapy. The results justify the need to develop a comprehensive outpatient support program focused on deprescribing, fall prevention, and cognitive impairment management.

Actually sepsis is one of the most important health problems, as the incidence of it in the world is high and continues to grow, and mortality reaches 40–60%, especially with the development of septic shock. Frequent heart damage in sepsis – septic cardiomyopathy (an established term for sepsis-caused by acute cardiac dysfunction syndrome unrelated to ischemia due to damage to the coronary arteries) – is often complicated by the occurrence of cardiac arrhythmias. Ventricular arrhythmias are rare, and atrial fibrillation develops in 20–30% of cases, reaching 45% with septic shock. At the same time, mortality increases by about 2–3 times if attempts at cardioversion are unsuccessful. However, the issues of antiarrhythmic therapy have not yet been regulated. The Russian and Eurasian clinical guidelines for the treatment of atrial fibrillation (2025) do not mention sepsis. And the recommendations of the European Society of Cardiology and the Association of Cardiothoracic Surgeons (2024), supplemented by the European Heart Rhythm Association (2025), only state that sepsis is a trigger for atrial fibrillation and a risk factor for its subsequent recurrence in almost half of the discharged patients with sepsis, and the degree of inflammation correlates with the frequency of its development and recurrence. Drugs commonly used for cardioversion – beta-blockers, calcium antagonists, amiodarone – can worsen the situation, negatively affecting the hemodynamics of septic patients, especially in shock. The culprits of the hipotensive effect of amiodarone, in particular, are due of the emulsifier polysorbate-80 and benzyl alcohol in its composition. Based on an analysis of current clinical studies and our own clinical experience, the article examines the use of propafenone in this case, devoid of cardiodepressive properties. It is also advisable to use levocarnitine adjuvantly, which has positive inotropic and antioxidant properties, as well as being able to resist inflammatory and proarrhythmic links in the pathogenesis of sepsis, and prevent recurrence.

Introduction. Thyroid nodules including thyroid cancer are among the common long-term effects of radiation therapy (RT) to the head and neck region administered for primary central nervous system (CNS) tumors and lymphomas.

Aim. To evaluate the frequency and different types of nodules and benign and malignant lesions in thyroid after head and neck irradiation for primary CNS tumors and lymphomas.

Materials and methods. Patients included in the retrospective trial were divided into 6 groups: group 1 – craniospinal irradiation (CSI) for primary CNS tumors under the age of 18 years, group 2 – CSI for primary CNS tumors above the age of 18 years, group 3 – RT to the neck region for lymphoma treatment in patients under the age of 18 years, group 4 – RT to the neck region for lymphoma treatment in patients above the age of 18 years, group 5 – control for patients irradiated before 18 years, group 6 – control for patients irradiated over the age of 18 years.

Results. Thyroid nodules were more common after neck irradiation for lymphoma comparing to CSI (47.1% vs 27%) (p = 0.032). Control groups had even lower nodules rates (p = 0.04). EU-TIRADS 3 were more common after neck irradiation for lympho ma than after CSI (p = 0.013). Female patients developed thyroid nodules more frequently than male (p = 0.001), especially EU-TIRADS 3 and EU-TIRADS 4 (p = 0.027). Furthermore thyroid volume was decreased in patients after irradiation comparing to control groups (p < 0.001).

Conclusions. Thyroid nodules are more common in head and neck irradiation than in general population. As there is a risk of cancer in thyroid nodules, thyroid ultrasound must be performed in patients with irradiation in history. It can help to detect serious lesions and provide appropriate treatment if it needs in time.

Introduction. One of the important issues at present is the scientific substantiation of the optimal duration of spa treatment for the most common diseases. Arterial hypertension (AH) is the most common risk factor for cardiovascular diseases, which are the leading cause of mortality in the Russian Federation.

Aim. To compare the clinical efficacy of spa treatment in patients with AH lasting 7, 14, 18 and 21 days.

Materials and methods. An open prospective randomized clinical study of 50 patients with hypertension was conducted. The patients were divided into 4 comparable groups depending on the duration of spa treatment: 7, 14, 18, 21 days. Before and after treatment, a general clinical examination, electrocardiography (ECG), Holter ECG monitoring, daily blood pressure monitoring, biochemical blood test, 6-minute walk test, testing using the quality of life test and the hospital anxiety and depression scale were performed. The treatment included diet therapy, lifestyle modification (smoking cessation, increased daily physical activity) and basic drug therapy, therapeutic exercise, dosed walking along terrain cure routes, dry gas-air carbon dioxide baths (Reabox, Russia), exposure to low-frequency magnetic therapy (Magnetomed 8400, Italy) and sinusoidal modulated currents (Intelect advanced, USA), manual massage.

Results. А statistically significant decrease in blood pressure and heart rate was noted in patients with a 7-day SCL period, an increase in exercise tolerance and quality of life in patients in the 7-day SCL groups, which were maintained during treatment periods of 14, 18 and 21 days.

Conclusion. The revealed dynamics of clinical indicators at different SCL periods and the assessment of the long-term spa treatment outcomes after one year will create a basis for developing a differentiated approach to determining the optimal spa treatment duration.

Introduction. The search for parameters reflecting the peripheral effects of thyroid hormones remains an important challenge. Fluorescence spectroscopy (FS) enables noninvasive assessment of tissue metabolism by measuring the fluorescence of reduced nicotinamide adenine dinucleotide (NADH), a key cofactor of oxidative phosphorylation.

Aim. To evaluate skin NADH fluorescence parameters as potential markers of energy metabolism disturbances in patients with primary hypothyroidism and to assess their association with age and body mass index (BMI).

Materials and methods. A cross-sectional study included 50 healthy volunteers and 51 patients with primary hypothyroidism
(14 overt and 37 subclinical). NADH fluorescence amplitude (AF_NADH) was measured using FS in forearm skin at baseline, during
local cooling (10 °C), heating (35 °C and 42 °C), and during an occlusion test.

Results. No differences in AF_NADH parameters were observed between groups at baseline or during functional tests. The only
finding was a reduced relative change in AF_NADH during cooling in subclinical hypothyroidism (p = 0.021). NADH fluorescence
parameters did not correlate with TSH, fT3, or fT4 after adjustment for age. In the overall sample, age was positively correlated
with AF_NADH, most strongly in healthy participants (r up to 0.51; p < 0.001). In this group, BMI was also correlated with AF_NADH
during thermal tests.

Conclusions. Skin NADH fluorescence parameters do not change in primary hypothyroidism. However, they are associated with
age, reflecting age-related alterations in cellular NADH metabolism (or fluorescence properties of the skin) and warrant further
investigation. The rate of NADH utilization during heating is associated with BMI.