Determining The Risk of Atrial Fibrillation Paroxysm in Patients With Chronic Heart Failure With Intact and Reduced Ejection Fraction.

AIM: To determine predictors for the development of atrial fibrillation (AF) in patients with chronic heart failure (CHF) with preserved and reduced ejection fraction by echocardiography (EchoCG) according to an extended protocol with determination of diastolic function and left atrial global strain. MATERIAL AND METHODS: Data of 168 patients with stage I-III CHF without a history of AF were analyzed. All patients underwent echocardiography according to an extended protocol with the determination of diastolic dysfunction (DD), left atrial ejection fraction (LA EF), and left atrial global strain (LA GS). Tissue Doppler imaging (TDI) was used to evaluate the early (E) and late (A) LV filling velocity and the early (E') and late (A') diastolic mitral annular velocity. In all patients, Holter ECG monitoring (HM ECG) of heart rhythm was performed for 3 days, and ECG monitoring with telemedicine technologies was performed for 7 days, 3 times a day for 3 minutes. The follow-up period was 3 months or until an AF episode. RESULTS: During the study, paroxysmal AF (pAF) was detected in 41 (24.4%) patients using various methods of heart rhythm monitoring. Complaints of palpitations were noted for 10 (24.4%) patients during pAF, which was recorded using a CardioQVARK® device, HM ECG or a 12-lead ECG. In 5 (12.2%) patients, daily ECG monitoring revealed pAF without associated complaints. HM ECG detected 8, 2, 4 (19.5%, 4.8%, and 9.7%) cases during 24, 48 and 72 hours, respectively; a single-channel CardioQVARK® detected 30 (73.2%) cases when used 3 times a day for 7 days. These results showed that AF frequently develops in CHF without accompanying symptoms. The method for detecting pAF with CardioQVARK® showed good results: it was twice more effective than HM ECG and three times more effective than 12-lead ECG. Also, according to ultrasound data, significant changes in the following parameters were noted in patients with AF: LA EF <36% (OR 1.04, 95% CI: 1.02-1.08), p=0.003; LA GS <9.9% (OR 1.16, 95% CI: 1.02-1.38), p<0.001; TDI E med <5.7 cm/s (OR 0.97, 95% CI: 0.94-1.00), p=0.026. Grade 2 DD did not show statistically significant results (OR 1.1, 95% CI: 0.7-1.5, p=0.54). However, it was detected more frequently in patients with AF, in 34% of cases, compared to 29% of cases in patients without AF, which requires further study on a larger patient sample. CONCLUSION: Patients with CHF have a high risk of developing pAF (24.4%). 75% of patients with AF do not feel the development of paroxysm. All CHF patients should undergo EchoCG with assessment of LA EF, TDI E med and LA GS to identify a group at risk for the development of AF. Heart rhythm remote monitoring with CardioQVARK® devices can be considered a reliable method for early detection of pAF and timely initiation of anticoagulant therapy in patients with CHF.

[Endoscopic transnasal resection of clival meningiomas]. / Rezul'taty endoskopicheskogo transnazal'nogo udaleniya meningiom oblasti skata.

BACKGROUND: Surgical treatment of ventral and ventrolateral meningiomas of posterior cranial fossa is difficult in modern neurosurgery. This is due to peculiarities of approach to these areas and concentration of critical structures (cranial nerves and great vessels). Currently, endoscopic transnasal approach to these meningiomas allows partial, and in some cases, total resection. However, this technique is not widespread. OBJECTIVE: To analyze the world literature data on postoperative outcomes in patients with clival and petroclival meningiomas after endoscopic transnasal resection. MATERIAL AND METHODS: We analyzed 22 articles representing treatment of 61 patients with clival and petroclival meningiomas. RESULTS: Total or near-total resection was achieved in 22.9% of cases, subtotal resection - 40.9%, partial resection - 26.2% (data were not provided in other cases). Even partial and subtotal resection leads to significant regression of symptoms. CONCLUSION: Endoscopic transnasal surgery is a full-fledged alternative to transcranial approaches in surgical treatment of clival meningiomas. It is also an additional option for patients with petroclival meningiomas after ineffective transcranial approaches. Transnasal tumor shrinkage and devascularization lead to brainstem decompression, regression of hydrocephalus and baseline clinical symptoms.

[Risk factors, treatment organization and quality indicators for chronic obstructive pulmonary disease in primary care settings: Dutch experience].

INTRODUCTION: Chronic obstructive pulmonary disease (COPD), usually in advanced stages, is associated with high mortality, being the third leading cause of death worldwide. In the Netherlands, care delivery to patients with COPD has become a focus of the regional medical community, since the COPD death rates in this country are higher than the European Union average. However, between 2011 and 2021, the number of people with COPD (under follow-u by general practitioners) decreased. The experience of this country is interesting, as a large set of measures to improve the situation has been developed and implemented in this region. The purpose of the study was to analyze the experience of the Netherlands in organizing medical care for COPD in primary care settings. MATERIAL AND METHODS: The search for scientific literature sources was carried out using the PubMed database and Google system. The search time horizon equaled to 5 years. RESULTS: In the Netherlands, in the system of care delivery to patients with COPD, primary care settings are heavily burdened. The article summarizes approaches to identify COPD risk factors, summarizes current clinical recommendations as of December 2022, and highlights findings of the study on medical digital platforms with the potential to organize continuous monitoring of patients. The paper exemplifies criteria for assessing the treatment quality in specialized care settings, including primary care. DISCUSSION: It is assumed that the most effective measure to further improve efficacy of COPD treatment is the introduction of remote digital medical devices. A possible integration of the updated standards and quality indicators into digital services will further strengthen the concept of continuous automated remote monitoring of COPD patients. Evidence-based selection and introduction of effective digital solutions into current practice will improve quality of care delivery to patients.

[Current status and prospects of using the prokinetic acotiamide in gastroenterology: A review].

Acotiamide is a prokinetic with a novel mechanism of action - an antagonist of muscarinic M1 and M2 receptors and an acetylcholinesterase inhibitor. Acetylcholine is the central mediator of the tone of the muscular components of the gastrointestinal tract, increasing its motor activity. Blockade of presynaptic M1 and M2 receptors neutralizes the inhibitory effect of the feedback mechanism on the acetylcholine synthesis, while inhibition of acetylcholinesterase in the synaptic cleft reduces the acetylcholine degradation. Currently, the clinical efficacy of acotiamide in the population of patients with functional dyspepsia is demonstrated in more than 10 clinical studies in different regions of the world, demonstrating a reduction of the symptoms of the disease during treatment with this agent and an improvement in the quality of life of patients. In addition, the combination of acotiamide with proton pump inhibitors optimizes the management of patients with gastroesophageal reflux disease.

[Exudative pericarditis with tamponade after COVID-19. Case report].

A description of a COVID-19 patient with the development of exudative pericarditis complicated by cardiac tamponade is provid. A peculiarity of this case is the presence of an underlying disease in the patient (chronic lymphocytic leukemia), which was in remission for 1.5 years after chemotherapy. Another feature of the patient was the relatively small area of lung damage and the hemorrhagic nature of the pericardial effusion, which persisted for a long time. The insignificant activity of inflammatory markers was noteworthy. Possible mechanisms of development and features of the course of exudative pericarditis in the described patient, issues of diagnosis and treatment of this category of patients are discusse.

[Tactics of anticoagulant therapy in patients with cardiac implantable electronic devices and subclinical atrial fibrillation: A review].

Screening for atrial fibrillation (AF) has attracted considerable attention recently. Of special interest are patients with cardiac implantable electronic devices (CIEDs) that allow for recording episodes of atrial arrhythmias of various durations, including asymptomatic ones, in which case they are referred to as subclinical atrial fibrillation (SCAF). The available data suggest that the risk of thromboembolic events varies between patients with SCAF and clinically overt AF. As of today, the question regarding anticoagulant therapy in patients with SCAF remains unresolved. The article presents an overview of previous and ongoing studies on this issue, as well as current guidelines on anticoagulant use in patients with SCAF and CIEDs.

The use of Dapagliflozin in Acute Decompensated Heart Failure: Results of the Randomized Study.

Aim      To determine the effect of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on kidney function in acute decompensated heart failure (ADHF).Material and methods  A controlled randomized study on the dapagliflozin treatment in ADHF was performed. Patients were randomized to a main group (standard therapy supplemented with dapagliflozin) or a control group (standard therapy for ADHF). The primary endpoint was the development of acute kidney injury (AKI). 200 patients were included (mean age, 74±12 years; 51% men). 31% of patients had type 2 diabetes mellitus (DM2). Mean left ventricular ejection fraction (LV EF) was 47±14 %; in 44.5% of patients, LV EF was less than 45%. Median concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) was 5225 [3120; 9743] pg / ml, glomerular filtration rate (GFR) was 51 [38; 64] ml / min / 1.73 m2.Results In-hospital mortality was 6.5%. Analysis of the dynamics of body weight loss showed significant differences (4200 [2925; 6300] g vs. 3000 [1113; 4850] g; p=0.011) in favor of the dapagliflozin group. The requirement for increasing the daily dose of furosemide and adding an another class diuretic (thiazide or acetazolamide) did not differ between the groups. However, median furosemide dose during the stay in the hospital was lower in the dapagliflozin group (80 [67; 120] mg vs. 102 [43; 120] mg; p=0.016). At 48 hours after randomization, GFR significantly decreased in the dapagliflozin group (-5.5 [-11; 3] ml/min/ 1.73 m2) compared to the control group (-0.3 [-4; 5] ml / min/1.73 m2, р=0.012). Despite this, GFR did not differ between the groups at discharge (51 [41; 66] ml/min/1.73 m2 and 49 [38; 67] ml/min/1.73 m2, respectively; p = 0.84). In the dapagliflozin group, frequency of AKI episodes was not increased compared to the control group (13 and 9.4%, respectively; p = 0.45).Conclusion      The dapagliflozin treatment in ADHF is associated with more pronounced body weight loss and lower average doses of loop diuretics during the period of stay in the hospital, with no associated clinically significant impairment of renal function.

The use of Dapagliflozin in Acute Decompensated Heart Failure: Results of the Randomized Study.

Aim      To determine the effect of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on kidney function in acute decompensated heart failure (ADHF).Material and methods  A controlled randomized study on the dapagliflozin treatment in ADHF was performed. Patients were randomized to a main group (standard therapy supplemented with dapagliflozin) or a control group (standard therapy for ADHF). The primary endpoint was the development of acute kidney injury (AKI). 200 patients were included (mean age, 74±12 years; 51% men). 31% of patients had type 2 diabetes mellitus (DM2). Mean left ventricular ejection fraction (LV EF) was 47±14 %; in 44.5% of patients, LV EF was less than 45%. Median concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) was 5225 [3120; 9743] pg / ml, glomerular filtration rate (GFR) was 51 [38; 64] ml / min / 1.73 m2.Results In-hospital mortality was 6.5%. Analysis of the dynamics of body weight loss showed significant differences (4200 [2925; 6300] g vs. 3000 [1113; 4850] g; p=0.011) in favor of the dapagliflozin group. The requirement for increasing the daily dose of furosemide and adding an another class diuretic (thiazide or acetazolamide) did not differ between the groups. However, median furosemide dose during the stay in the hospital was lower in the dapagliflozin group (80 [67; 120] mg vs. 102 [43; 120] mg; p=0.016). At 48 hours after randomization, GFR significantly decreased in the dapagliflozin group (-5.5 [-11; 3] ml/min/ 1.73 m2) compared to the control group (-0.3 [-4; 5] ml / min/1.73 m2, р=0.012). Despite this, GFR did not differ between the groups at discharge (51 [41; 66] ml/min/1.73 m2 and 49 [38; 67] ml/min/1.73 m2, respectively; p = 0.84). In the dapagliflozin group, frequency of AKI episodes was not increased compared to the control group (13 and 9.4%, respectively; p = 0.45).Conclusion      The dapagliflozin treatment in ADHF is associated with more pronounced body weight loss and lower average doses of loop diuretics during the period of stay in the hospital, with no associated clinically significant impairment of renal function.

[Endoscopic transnasal resection of clival meningiomas]. / Endoskopicheskoe transnazal'noe udalenie meningiom skata.

Treatment of clival meningiomas is still one of the unresolved issues in modern neurosurgery. There are several treatment strategies. These ones include various combinations of follow-up, surgical CSF drainage, tumor resection and radiotherapy. OBJECTIVE: To assess postoperative outcomes in patients with clival meningiomas. MATERIAL AND METHODS: We analyzed 18 patients with large or giant clival meningiomas. RESULTS: We assessed extent of resection using the scale by G. Frank and E. Pasquini (2002): total resection - 95-100%, subtotal - 80-95%, partial - 50-80%, extended biopsy - <50% of tumor. Total resection was achieved in 1 patient (5.5%), subtotal - 5 (27.8%), partial - 12 (66.7%). At the same time, brainstem decompression and regression of hydrocephalus were observed in all cases. Fourteen patients were followed-up. Median follow-up was 8.5 months. Seventeen patients underwent radiotherapy due to predominant partial and subtotal resection. Total focal dose ranged from 50 to 57 Gy in standard fractionation mode. None patient had residual tumor enlargement throughout the follow-up period. There were no lethal outcomes. CONCLUSION: Endoscopic transnasal access to clival meningiomas in appropriate anatomical features of tumor and surrounding structures is a full-fledged alternative to transcranial treatment in these patients. This approach provides total resection and brainstem decompression. These facts increase life expectancy without deterioration of the quality of life.

[Minimally invasive surgery for invaginated CII odontoid process]. / Miniinvazivnaya khirurgiya invaginirovannogo zubovidnogo otrostka CII pozvonka.

Odontoidectomy is indicated for anterior compression of the brainstem by invaginated odontoid process. This procedure can currently be performed via transoral microsurgical and transnasal endoscopic access. OBJECTIVE: To analyze the results of endoscopic transnasal odontoidectomy. MATERIAL AND METHODS: We assessed treatment outcomes in 10 patients with anterior compression of the brainstem by invaginated odontoid process. All patients underwent endoscopic transnasal odontoidectomy. RESULTS: Brainstem decompression was achieved in all cases. CONCLUSION: Currently, endoscopic transnasal approach is gradually replacing the transoral one in some patients requiring anterior odontoidectomy. Analysis of literature data reflects the development of this technique taking into account various features of surgical treatment including optimization of dimensions of surgical field, attempts to perform C1-sparing surgeries and analysis of sufficient size of trepanation. Nasopalatine and nasoclival lines are used to select optimal access. Nevertheless, the choice of access depends on equipment of the hospital and surgical experience in most cases.

[Irritable bowel syndrome in the Russian Federation: results of the ROMERUS multicenter observational study].

BACKGROUND: Irritable bowel syndrome (IBS) is one of the most common functional disorders of the gastrointestinal tract. According to Russian guidelines, a standard examination using laboratory and instrumental evaluation methods, including colonoscopy, should be performed to establish the diagnosis of IBS. AIM: To characterize the Russian population of IBS patients. MATERIALS AND METHODS: A multicenter observational prospective study ROMERUS was conducted at 35 clinical centers in the Russian Federation. The study included male and female patients aged 18 to 50 with a diagnosis of IBS based on the Rome IV criteria, with no signs of structural gastrointestinal disease. The follow-up duration was 6 months and included three patients' visits to the study site. During the study, data were collected on patients' demographic and clinical characteristics, medical history, and drug therapy. The secondary parameters included the assessment of the proportion of patients with a diagnosis of IBS confirmed by a standard examination among all patients meeting the Rome IV criteria, the evaluation of the change over time of the IBS symptoms, quality of life (QoL), and adherence to therapy. Characterization of the population was performed using descriptive statistics methods. The standard examination results were presented as the percentage of patients with IBS confirmed by the standard examination among all patients meeting the Rome IV criteria, with a two-sided 95% confidence interval. RESULTS: The study included 1004 patients with a diagnosis of IBS according to the Rome IV criteria, with 790 (78.7%) patients included in the final analysis. The mean age of patients was 34.0±7.5 years; they were predominantly female (70.4%), Caucasian (99.4%), married (55.1%), urban residents (97.5%) with higher education (64.5%) and a permanent position (74.9%). Patients enrolled in the study have low physical activity and lack a healthy diet. The smoking rate was 26.3%. IBS symptoms with predominant constipation (IBS-C) were observed in 28.1% of patients; 28.9% had IBS with predominant diarrhea (IBS-D), 11.9% had mixed-type IBS, and 31.1% had non-classified IBS. The main IBS symptoms were pain (99.7%), abdominal distension (71.1%), and fullness (36.8%). Biliary tract dysfunction (18.9%) and gastritis (17.2%) were the most frequently reported comorbidities. Prior to enrollment, 28% of patients received drug therapy. The most commonly prescribed drug during the study was mebeverine (54.1%). At 6 months of follow-up, there was a significant reduction of abdominal pain, bloating, and distention, and a twofold reduction in the incidence of constipation and diarrhea in the subgroups of patients with IBS-C and IBS-D, respectively. The overall QoL score measured by the IBS-QoL questionnaire increased from 83.0 to 95.2 points (p<0.05) during the study. In the overall assessment of their condition, 69.6% of patients noted no symptoms and 25.3% reported marked improvement, 35% were asymptomatic according to the physician's overall assessment of the patient's condition, and 51.8% showed significant improvement. CONCLUSION: IBS patients in the Russian Federation were characterized. The diagnosis of IBS, established following the Rome IV criteria, is confirmed by the results of a standard examination in 96.3% of patients. The Rome IV criteria for the IBS diagnosis make it possible to establish a diagnosis with a probability of 94.7%. For 6 months of follow-up, there was a clinical improvement with a decrease in the severity of symptoms and a QoL improvement.

[Comparative analysis of the intestinal microbiota in patients with exocrine pancreatic insufficiency of various severity].

BACKGROUND: Exocrine pancreatic insufficiency (EPI) is a critical host factor in determining the composition of the gut microbiota. Diseases that cause exocrine insufficiency can affect the gut microbiome, which can potentiate disease progression and complications. To date, the relationship of exocrine insufficiency in various pancreatic (PA) pathologies, in chronic pancreatitis (CP), with dysbiotic changes in the intestinal microbiota (IM) has not been reliably studied. The available data are heterogeneous and contradictory, which determines the need for further research. AIM: To conduct a comparative analysis of the taxonomic composition of the intestinal microbiota in patients with CP of various etiologies, without or with the presence of EPI of varying severity, as well as patients with severe EPI with a history of surgical intervention (SI) on the pancreas. MATERIALS AND METHODS: A total of 85 patients were included in the study. Patients were divided into groups according to the severity of EPI: Group 1 (n=16) - patients with CP without EPI; Group 2 (n=11) - patients with CP and mild EPI; Group 3 (n=17) - patients with severe CP and EPI; Group 4 (n=41) - severe EPI in persons with a history of SI on the pancreas. Verification of CP was carried out according to clinical, anamnestic and instrumental data. The degree of EPI was determined by the level of pancreatic elastase-1 (PE-1) feces. Informed consent for the study was obtained for each patient, an anamnesis was collected, physical and laboratory examinations were performed, and a stool sample was obtained. DNA was extracted from each stool sample, the taxonomic composition of BM was determined by sequencing the bacterial 16S rRNA genes, followed by bioinformatic analysis. RESULTS: We followed the changes in the gut microbiota from a group of patients with CP without EPI to a group with severe EPI, in those who underwent SI. At the level of the phylum, the IM of all groups showed the dominance of Firmicutes, with the lowest representation in the severe EPI group, both with SI and CP, and the growth of the Actinobacteria, Verrucomicrobiota and Fusobacteria types. The differential representation of childbirth varied: in patients with severe EPI and CP, compared with mild, statistically significant genera - Akkermansia, Ruminococcus gauvreauii group and Holdemanella; compared with CP without exocrine insufficiency, Prevotella, Ruminococcus gauvreauii group, Peptostreptococcus and Blautia dominated. The CP group with mild EPI was dominated by the following genera: Lachnospiraceae_ND 2004 group, Faecalitalea, Fusobacterium, Catenibacterium, Roseburia, Atopobium, Cloacibacillus, Clostridium innococum group, Ruminococcus torques group. All groups showed a low diversity of taxa with a predominance of opportunistic flora, including participants in oncogenesis. CONCLUSION: The results of the study show that patients with CP of various etiologies and patients with severe EPI who underwent specific intervention on the pancreas have intestinal microbiota dysbiosis, the severity of which is significantly influenced by the degree of EPI.

[Effectiveness of empirical Helicobacter pylori eradication therapy with furazolidone in Russia: results from the European Registry on Helicobacter pylori Management (Hp-EuReg)].

BACKGROUND: First-line therapy does not always provide a high level of Helicobacter pylori eradication due to the increase of H. pylori resistance to antibiotics; therefore, it remains necessary to identify the most effective rescue treatments. The purpose of this study was to evaluate the efficacy and safety of empirical H. pylori furazolidone-containing regimens. MATERIALS AND METHODS: Adult H. pylori infected patients empirically treated with furazolidone-containing eradication regimens were registered in an international, prospective, multicenter non-intervention European registry on H. pylori management (Hp-EuReg). Data were collected at AEG-REDCap e-CRF from 2013 to 2021 and the quality was reviewed. Modified intention-to-treat (mITT) effectiveness analyses were performed. RESULTS: Overall 106 patients received empirical furazolidone-containing therapy in Russia. Furazolidone was prescribed in a sequential scheme along with amoxicillin, clarithromycin and a proton pump inhibitor in 68 (64%) cases, triple regimens were prescribed in 28 (26%) patients and quadruple regimens in 10 (9.4%). Treatment duration of 7 days was assigned to 2 (1.9%) patients, 10-day eradication therapy in case of 80 (75%) and 14 days - in 24 (23%) patients. Furazolidone was mainly used in first- (79%) and second-line (21%) regimens. The methods used to diagnose H. pylori infection were: histology (81%), stool antigen test (64%), 13C-urea breath test (6.6%), and rapid urease test (1.9%). The mITT effectiveness of sequential therapy was 100%; 93% with the triple therapy and 75.5% with quadruple therapy. Compliance was reported in 98% of cases. Adverse events were revealed in 5.7% of patients, mostly nausea (3.8%). No serious adverse events were reported. CONCLUSION: Furazolidone containing eradication regimens appear to be an effective and safe empirical therapy in Russia.

[Efficacy of esophagus protection in complex treatment of erosive gastroesophageal reflux disease: a systematic review and meta-analysis of controlled trials].

AIM: To review the data about the efficacy of esophagus protective agent based on the fixed combination of hyaluronic acid and chondroitin sulfate dissolved in the bioadhesive carrier (poloxamer 407) in the complex therapy of patients with erosive gastroesophageal reflux disease (GERD). MATERIALS AND METHODS: A search in MEDLINE/PubMed, EMBASE, Cochrane, and Russian Science Citation Index of Scientific Electronic Library electronic databases was performed. Relevant original controlled studies of a fixed combination of hyaluronic acid and chondroitin sulfate as an esophagus protective agent in a population of patients with erosive GERD were included. RESULTS: The final analysis included three studies that enrolled 181 patients with erosive GERD. All the studies had a uniform design with the assessment of the primary endpoints (complete epithelialization of esophageal erosions and complete resolution of heartburn) 28 days after the start of therapy. Meta-analysis of the three controlled trials has demonstrated that combination therapy with proton pump inhibitors (PPIs) and esophagus protective agents is significantly more effective than PPI monotherapy for complete epithelialization of esophageal erosions at 28 days of treatment (relative risk 1.267, 95% confidence interval 1.082-1.483, p=0.003; I2=21.19%), but did not differ for complete resolution of heartburn on the day 28 of treatment (relative risk 1.638, 95% confidence interval 0.660-4.067, p=0.287; I2=92.59%). CONCLUSION: Combined therapy with PPI and Alfasoxx is significantly more effective than PPI monotherapy for the epithelialization of esophageal erosions in patients with erosive GERD.

[Clinical features of asthenic disorders in chronic heart failure]. / Klinicheskie osobennosti astenicheskikh rasstroistv pri khronicheskoi serdechnoi nedostatochnosti.

OBJECTIVE: The aim of the study is to study the clinical features of asthenic disorders in chronic heart failure (CHF) considering the reaction to the disease. MATERIAL AND METHODS: 62 inpatients with CHF II-IV functional class (FC) according to NYHA were examined. Research methods included somatic, psychopathological and pathopsychological examination using psychometric scales. RESULTS: According to a pathopsychological study using the Multidimensional Fatigue Inventory (MFI-20), asthenic disorders were discovered in all examined patients, realized mainly by «general fatigue¼ (75.8%) and «physical fatigue¼ (72.6%), more rarely «mental fatigue¼ was observed (32.2%). Correlations of «general fatigue¼ with the age of patients were revealed (p=0.018). There was a relationship between the severity of asthenic disorders and the severity of CHF, as evidenced by the correlation between «general fatigue¼ and reduced ejection fraction (EF) of the left ventricle (p=0.005), as well as «physical fatigue¼ and FC according to NYHA (p=0.022). The negative impact of all components of the dimensions of asthenic disorders on the quality of life was determined (p<0.05). According to the concept of the formation of different perceptions of the manifestations of a somatic disease, two types of reactions to asthenic disorders were identified: 1. Dissociative reactions, manifested by a discrepancy between the severity of CHF and a subjective assessment of the condition with an underestimation of the asthenic symptoms denial of its influence on the usual lifestyle and associated with an unfavorable course of CHF and 2. Adaptive reactions, realized by a harmonious perception of asthenia, awareness of the need to change lifestyle considering the presence of CHF symptoms. CONCLUSION: In accordance with the results, the described clinical features of asthenic disorders allow to distinguish asthenia in CHF and other pathology, and the identified types of reactions can contribute to the timely verification of asthenia, prevention of further progression of CHF, and the development of appropriate treatment approaches.

Predictors of tachycardia-induced cardiomyopathy in patients with first-time decompensation of chro-nic heart failure with reduced left ventricular ejection fraction of nonischemic etiology and persistent atrial tachyarrhythmia.

Aim    To identify possible predictors of tachycardia-induced cardiomyopathy (TICMP) in patients with newly developed decompensated chronic heart failure (CHF) of nonischemic origin with reduced left ventricular ejection fraction (LV EF) and with persistent atrial tachyarrhythmias. Material and methods    This study included 88 patients with newly developed decompensated CHF of nonischemic origin with reduced LV EF and persistent atrial tachyarrhythmias. Resting 12-lead electrocardiography (EGC) and transthoracic echocardiography (EchoCG) were performed upon admission and following the electrical impulse therapy for all patients. Also, 24-h ECG monitoring was performed to confirm sinus rhythm stability. After recovery of sinus rhythm, outpatient monitoring was performed for three months, including repeated EchoCG to evaluate the dynamics of heart chamber dimensions and LV EF. Results    The patients were divided into two groups based on the increase in LV EF: 68 responders (TICMP patients with a LV EF increase by >10%) and 20 non-responders (patients with an increase in LV EF by <10% during 3 months following the sinus rhythm recovery). According to results of the baseline EchoCG, LV EF did not significantly differ in the two subgroups (TICMP, 40±8.3 %, 18-50 % and non-responders, 38.55±7.9 %, 24-50 %); moreover, the incidence of cases with LV EF <30% did not differ either (9 patients TICMP and 2 non-responders, р=1.0). TICMP patients compared to non-responders, had significantly smaller left atrial dimensions (4.53±1.14 (2-7) cm and 5.68±1.41 (4-8) cm, р=0.034; 80.8±28.9 (27-215) ml and 117.8±41.3 (46-230) ml, р=0.03, respectively) and left ventricular end-systolic volume (ESV) (67.7±33.1 (29-140) ml and 104.5±44.7 (26-172) ml, р=0.02, respectively). The effect of major EchoCG parameters on the probability of TICMP development was assessed by one-factor and multifactor regression analyses with adjustments for age and sex. The probability of TICMP increased with the following baseline EchoCG parameters: end-diastolic volume (EDV) <174 ml [odd ratio (OR), 0.115, 95 % confidence interval (CI): 0.035-0.371], ESV <127 ml [OR, 0.034, 95 % CI: 0.007-0.181], left atrial volume <96 ml [OR, 0.08 , 95 % CI: 0.023-0.274], right ventricular dimension <4 cm [OR, 0.042 , 95 % CI: 0.005-0.389].Conclusion    Among patients with newly developed decompensation of CHF with reduced LV EF of non-ischemic origin and persistent atrial arrhythmias, TICMP was detected in 72 % of patients. The probability of TICMP did not depend on baseline EF and duration of arrhythmias, but increased with the following baseline EchoCG parameters: EDV< 174 ml, ESV< 127 ml, left atrial volume <96 ml, right ventricular dimension <4 cm. The multifactorial analysis showed that a right atrial volume <96 ml is an independent predictor for the development of TICMP.

[Efficacy of Saccharomyces boulardii CNCM I-745 probiotic drug in the prevention and treatment of diarrhea in hospitalized patients with new coronavirus infection COVID-19].

AIM: To evaluate the efficacy of Saccharomyces boulardii (S. boulardii) CNCM I-745 probiotic drug in preventing and treating diarrhea in hospitalized patients with COVID-19. MATERIALS AND METHODS: A prospective comparative study was conducted in two parallel groups. The study included males and females aged 18 to 60 with the following diagnosis confirmed by polymerase chain reaction: U07.2 Coronavirus infection COVID-19, caused by SARS-CoV-2 virus (grade 1-3 pneumonia according to CT scan). All patients received antibiotic therapy. The patients were subdivided into two equal groups (n=60) depending on the administration of S. boulardii CNCM I-745 probiotic drug in addition to standard treatment. The probiotic was prescribed by the attending physician; the dose was 2 capsules per day (500 mg/day) 30 min before the meal for 10 days. All patients were monitored for main clinical, laboratory, and instrumental parameters during the study. In addition, the symptom of diarrhea (stool with a frequency of more than 3 times a day of type 6 and 7 according to the Bristol stool scale), including its frequency, duration, and the number of bowel movements of loose stool per day were precisely evaluated in both groups. RESULTS: In the overall patient pool, diarrhea was reported in 21.7% of in-patients during the observation period (95% confidence interval [CI] 14.2-29.1) with a mean duration of 4.6154 days (95% CI 3.7910-5.4398). The incidence of diarrhea in group 1 was 13.3% (95% CI 4.5-22.2), and in group 2, it was 30.0% (95% CI 18.1-41.9). Relative risk showed that the use of the S. boulardii CNCM I-745 probiotic drug leads to a significant reduction in the risk of diarrhea in hospitalized patients with COVID-19 infection receiving antibiotic therapy (odds ratio [OR] 0.3590, 95% CI 0.1421-0.9069; p=0.0303). In group 1, the duration of diarrhea was 3.1250 days (95% CI 2.5892-3.6608) versus 5.2778 days (95% CI 4.2290-6.3265) in group 2, p=0.0112. The mean daily frequency of loose stools in patients with diarrhea in group 1 was 3.2500 (95% CI 2.6588-3.8412) versus 4.3889 (95% CI 3.7252-5.0525) in group 2, p=0.0272. The secondary endpoint, duration of hospital stay, was also significantly shorter in group 1 patients - 11.6833 days (95% CI 11.2042-12.1625) versus 12.7333 days (95% CI 12.1357-13.3309) in group 2, p=0.0120. CONCLUSION: The present prospective comparative study demonstrated that adding S. boulardii CNCM I-745 probiotic drug into the standard treatment regimen of patients with new coronavirus infection COVID-19 receiving antibiotic therapy helps reduce the incidence of diarrhea and its severity during hospitalization, as well as the duration of hospital stay.

[Social and psychological risk factors for decreased adherence among patients with atrial fibrillation].

Adherence has a direct impact on reducing the effectiveness of atrial fibrillation therapy and increasing the risk of thromboembolic events. Among the factors involved in the decrease of adherence, the social and psychological characteristics of patients remain insufficiently studied. At the same time, the available publications allow us to conclude that there are markers of the risk of reduced adherence in patients with atrial fibrillation, which include age, cognitive impairment, psychoemotional disorders (including depression and anxiety) and specific behavioral patterns.

[EXPERIENCE IN ORGANIZING THE WORK OF THE CENTER FOR PERSONALIZED TREATMENT OF MALIGNANT NEOPLASMS (NETHERLANDS)].

INTRODUCTION: In the last decade, there has been a «breakthrough¼ development of scientific approaches to the assay of genomic and immune factors underlying anti-cancer treatment efficiency. The choice of antitumor therapy in practice is increasingly determined by molecular signatures, and not only by the specificity of organ tumor originated from (or by the histological properties of the tumor). An urgent and important scientific and practical task is to study the successful experience of organizing Centers for Personalized Cancer Treatment (CPCT). AIM: analysis of the 10-year experience of the Clinical Center for Personalized Cancer Treatment in the Netherlands. MATERIALS AND METHODS: Data were extracted from the internet databases using keywords: personalized cancer therapy / treatment, cancer, targeted therapy etc.Results. The Center's research project collects data on patients with metastatic cancer who are eligible for anticancer treatment as part of standard practice. The system accumulates various information about tumor DNA, mutations and abnormalities in DNA, treatment results (outcomes), as well as other important clinical characteristics, including individual tumor process. Registered parameters are stored in a digital database and are available for scientific research. DISCUSSION AND CONCLUSIONS: CPCT consider the possibilities for the more in-depth genomic analysis of patient DNA (including non-tumor DNA) in the future in order to improve the medical decision making regarding early diagnosis and personalized choice of anticancer therapies. Rapid progress will lead to the emergence of more advanced methods for re-evaluating biological samples accumulated in biobanks, that will facilitate the understanding the pillars of personalized anti-cancer treatment approaches as well as create an additional bases for the new drug development.

[The effectiveness of eradication therapy of the 1st line of Helicobacter pylori infection in patients with type 2 diabetes mellitus].

AIM: Evaluation of the efficacy and safety of eradication therapy of infection Helicobacter pylori in patients with H. pylori- associated pathology of the upper gastrointestinal tract and concomitant type 2 diabetes mellitus (DM). MATERIALS AND METHODS: The prospective randomized study involving 180 patients (87 men and 93 women) with H. pylori- associated pathology of the upper gastrointestinal tract was carried out. The patients were divided into four groups of 45 people: 1 patients without diabetes who received the classic triple eradication therapy; 2 patients with type 2 DM who received the classic triple eradication therapy; 3 patients without DM who underwent quadrotherapy with bismuth preparations; 4 patients with type 2 DM who underwent quadrotherapy with bismuth preparations. Eradication therapy was carried out for 14 days. Evaluation of the effectiveness of eradication using a breath test was carried out 4 weeks after completion of the course of treatment. Eradication success was assessed separately for ITT and PP analyzes. RESULTS: The effectiveness of classical triple eradication therapy in patients with concomitant type 2 DM is 64.4% in the ITT group and 69.05% in the PP: quadrotherapy 73.34 and 80.49%, respectively. The effectiveness of first line eradication therapy is higher in patients without DM compared with groups of patients with concomitant type 2 DM: ITT 83.33%, PP 88.23% and ITT 68.89%, PP 74.70%, respectively. The incidence of side effects in patients with type 2 DM: with the use of classical triple therapy 22.23%, quadrotherapy 31.12%. CONCLUSION: The data of the study of the efficacy and safety of line I eradication therapy make it possible to recommend the four-component therapy based on bismuth for use in clinical practice, especially in patients with DM.