Vol 79, No 3 (2024)

Cardiovascular disease is a major cause of higher mortality of middle-aged and elderly males in comparison to women. Sex hormones action on cardiovascular system is the most likely explanation of this differences. Nevertheless, estradiol and cardiovascular disease relationship is still unclear. The authors conducted a systematic review to identify the association of endogenous estradiol with cardiovascular endpoints in men. Articles were identified by a MedLine search (1961 — July 2023) and citation tracking. No evidence synthesis was conducted. 24 eligible articles were found. In 10 studies no association of sex hormones and endpoints was found. In 7 studies there was an association of testosterone and endpoints, but no significant results for estradiol. 7 studies have reported significant association of estradiol and cardiovascular endpoints. Inconsistency in evidence is significantly influenced by differences between studies in patient age, follow-up, researched endpoints and quality of estradiol essay. Over 40% of published studies, that researched the association of estradiol and death, found such a link. However, existing body of literature is largely heterogenous and doesn’t provide definite evidence for a pronounced net effect of estradiol on cardiovascular health in general men population. The present systematic review hints, that endogenous estradiol could be linked with cardiovascular risks in white men of young and middle age.

Background. Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common complications of chemotherapy for hemoblastoses in children, which, according to researchers, occurs in 30–100% of patients in the treatment of acute lymphoblastic leukemia (ALL). Reliable laboratory markers of this disease have not been established, while their use would be appropriate in patient monitoring.

Aims — to establish the clinical value of determining the stromal cell factor (SDF-1, CXCL12) in the laboratory monitoring of chemotherapy-induced polyneuropathy in the treatment of ALL in children.

Methods. A single-center prospective cohort non-randomized study was conducted in the period from 2019 to 2022 of patients with ALL treated with vincristine as the main treatment. Some of them developed vincristine-induced peripheral polyneuropathy as a variant of CIPN during treatment. On this basis, all patients were divided into two groups — with CIPN (main) and without peripheral polyneuropathy (comparison group). A clinical neurophysiological study was performed, as well as the determination of stromal cell factor (SDF- 1, CXCL12) in the plasma and cerebrospinal fluid (CSF) of patients at different stages of therapy.

Results. In the blood plasma of children with CIPN, the content of SDF-1 did not differ from the of healthy children and the comparison group, and during chemotherapy there was a tendency to decrease its level. In the CSF of patients of the main group the concentration of SDF-1 increased at the end of induction. The clinical value of this parameter was determined, with its content in the CSF > 410 pg/ml AUC = 0.75; OR = 2.200.

Conclusion. One of the candidates for the role of a laboratory marker of chemotherapy-induced peripheral polyneuropathy is the chemokine SDF-1, the concentration of which in the CSF increased in patients with ALL. In this study, the clinical value of this parameter has been established, on the basis of which it can be concluded that this laboratory parameter allows the diagnosis of CIPN with moderate accuracy, and the joint determination of this factor in blood and liquor slightly increases the accuracy of diagnosis.

Background. There is evidence that platelet dysfunction in new-type coronavirus infection can lead to both thrombotic and hemorrhagic events: hypercoagulation syndrome leading to thrombosis is one of the most threatening complications of COVID-19; equally important is the hemorrhagic syndrome that can be observed after this disease. The study of platelet aggregation function in children with new-onset coronavirus infection is highly relevant: the results of aggregometry in pediatric practice may help to predict the development of complications from vascular and platelet hemostasis.

Aims — to evaluate the direction of changes in platelet haemostasis in children undergoing COVID-19.

Methods. In the first phase of the work, we clarified the normal values of platelet aggregation in children with different inducers in whole blood by impedance testing (based on examination data from 105 conditionally healthy children who had not had COVID-19). At the second (main) phase of the study we conducted a single-stage prospective study including 250 pediatric patients residing in the Russian Federation: 143 children suffered mild COVID-19, while the comparison group consisted of 107 patients who had not been ill with a new-type coronavirus infection. All children (those who had COVID-19 and those who had no disease) underwent a comprehensive examination, which included: physical examination, aggregometry and laboratory tests (to rule out acute inflammatory process and hemogram abnormalities potentially affecting platelet aggregation rates).

Results. Almost half of the patients after COVID-19 had platelet aggregation abnormalities. At the same time, in every third child there were combined multidirectional disorders in the form of hypo- and hyperaggregation with different inducers, in contrast to the group of children who did not have COVID19 (p < 0.05). In the COVID19 group aggregation abnormalities with arachidonic acid were most frequently detected: almost every second patient had hyperaggregation and every fourth patient had hypoaggregation, which was statistically significantly different from the non-disease group (p < 0.05). Analysis of the results depending on the time interval after the disease (1–3 months, 3–6, 6–12 months, more than 12 months) showed platelet hyperaggregation with all inducers at 1–3 months, and there was a tendency to reduce aggregation with thrombin and ADP, but hyperaggregation with arachidonic acid persisted for one year after the disease. At an interval of more than one year after COVID-19 every second patient showed a decrease in platelet function (hypoaggregation with all inducers). No statistically significant differences by gender were observed depending on the time interval after the infection.

Conclusions. The results of the study demonstrate the vectors of impaired vascular and platelet hemostasis in children with mild COVID-19: The time intervals of platelet dysfunction after the disease have been determined. The results of the study may help to develop a surveillance strategy for children who have had a new type of coronavirus infection to prevent the development of complications from vascular and platelet hemostasis.

Background. Superior mesenteric artery (SMA) syndrome is a serious, potentially fatal complication that can be reversed by spinal deformity surgery. The protocol describes no more than 400 cases, and the risk factors for this development are clearly not known.

Aims — analysis of the results of CT angiography of the abdominal aorta in patients with severe scoliotic spinal deformity to identify risk factors for the development of superior mesenteric artery syndrome.

Methods. At the Department of Spinal Pathology and Neurosurgery of the Federal State Budgetary Institution “National Medical Research Center for Pediatric Traumatology and Orthopedics named after G.I. Turner” of the Ministry of Health of Russia CT angiography of the abdominal aorta in 13 pediatric patients with severe scoliotic deformities of the spine was performed. The direction of the SMA branch from the aorta, the aortomesenteric angle and the distance between the anterior wall of the aorta and the posterior wall of the SMA at the level of the duodenum (DU) were determined. If the values of the last two parameters deviated from the norm, patients underwent videogastroduodenoscopy to assess the condition of the duodenum and the patency of its subbulb part.

Results. In 4 patients branch a. mesenterica superior was left-sided, in 3 of these patients, when performing videogastroduodenoscopy, signs of compression of the extra-bulbular region from the outside were revealed — 1 patient developed SMA syndrome in the post-op period, which required drainage intervention on the intestine. When conducting a more thorough assessment of MSCT data, it was found that in the presence of severe deformity of the spinal column, infringement of the horizontal portion of the duodenum can occur between a. mesenterica superior and the ventral surface of the vertebral bodies. In a number of patients with a decrease in the aortomesenteric angle, compression of the duodenum was not observed due to its lower location and the increased distance between the anterior wall of the aorta and the posterior wall of the SMA at this level.

Conclusions. Possible risk factors for the development of SMA syndrome include the left-sided direction of branch a. mesenterica superior from the aorta. In some cases, in patients with clinical signs of SMA syndrome, infringement of the horizontal portion of the duodenum may occur between a. mesenterica superior and the spinal column, and not the aorta. The traditional method of measuring the aortomesenteric distance is not always correct — in patients with spinal deformity and clinical signs of SMA syndrome, due to the presence of changes in the spatial position of the internal organs, this distance must be measured at the level of the horizontal portion of the duodenum.

The available data on the role of polypragmasia in increasing the frequency of multiple drug interactions, when one drug interacts with two or more other drugs, increasing the risk of side effects associated with them, are considered. The application of network analysis and artificial intelligence to predict the development of clinically significant adverse reactions in conditions of polypharmacotherapy is described. The mechanisms of pharmacodynamic and pharmacokinetic interaction of drugs in the development of adverse reactions are considered and drugs potentially carrying an increased risk in multiple drug interactions are noted. The most dangerous drugs involved in drug interactions were psychotropic drugs, which accounted for about a third of all applicable medicines. The most common serious potential complications associated with this interaction were serotonin syndrome, seizures, QT prolongation, and bleeding. Graph probabilistic models, machine learning models for analyzing reliable sources of medical data, factor models that allow assessing the risks of taking two or more drugs together are proposed. These models are implemented in software and can be implemented in clinical decision support systems. It is concluded that the use of artificial intelligence can reduce the risk of adverse reactions during polypharmacotherapy, especially in elderly patients.

Background. In conditions of low insolation, which is typical for the northern regions of the Russian Federation, manifestations of low vitamin D availability often occur latently and for a long time unrecognized. This problem is especially relevant in young people, due to the failure to reach peak bone mass, which later determines the bone mineral density.

Aims — to determine the prevalence of deficiency and insufficient supply of 25(OH)D in blood serum in the spring, their impact on the indicators of physical development and bone mineral density among cadets of a military higher educational institutions.

Methods. We examined 198 cadets, studying in the first and fourth years of military higher educational institutions in St. Petersburg at the age of 17–25 years. As part of the study, a study of 25(OH)D in blood serum was performed, bone mineral density, muscle strength, anthropometric data, and body composition were additionally determined. The study was conducted in March–May 2023.

Results. The optimal content of 25(OH)D was found only in 22 (11.1%) cadets, while the most pronounced deficiency was registered in boys of fourth of study. It was established that the 25(OH)D level of first year cadets, who arrived from the southern regions of the Russian Federation (21.6 (18.1; 26.3) ng/ ml), was significantly different from the content of 25(OH)D in cadets who arrived from the middle zone (Me 18.7 (16.4; 21.4) ng/ml) (p = 0.017) and northern regions of the Russian Federation (Me 15.2 (13.6; 19.3) ng/ml) (p = 0.022). A decrease in the Z-criterion ≤ –2.0 SD was noted among cadets, mainly in the first year. It was revealed that muscle and fat mass were higher in fourth year boys, however, their muscle strength was not statistically significantly different from that of first year and muscle strength indicators did not depend on the availability of 25(OH)D. Increasing BMI was associated with higher muscle mass (p = 0.0004) and fat mass (p = 0.0006), with muscle strength (p = 0.026) and physical fitness performance (p = 0.012) among cadets with increasing BMI were significantly better compared to cadets who had an optimal BMI.

Conclusions. The results obtained indicate that cadets of a military higher educational institutions of St. Petersburg experience 25(OH)D deficiency and insufficiency, against the background of increased physical activity and prolonged stay in conditions of reduced insolation. This fact indicates the need to correct vitamin D hypovitaminosis in order to prevent osteopenic syndrome and improve physical performance.

The article discusses the process of formation and further development of epidemiology at a new post-classical stage in the formation of science. In the first period of the formation of science (XVII century), its activities were carried out only through the intra-disciplinary development of knowledge, and its last stage (post-classical period falling on the present) is based on the development of interdisciplinary ties. This approach allows us to identify previously seemingly distant and purely specific subject areas and discover new research subjects that cannot be discovered and accordingly used in internal disciplinary analysis. In the post-classical period of science, the formation of modern epidemiology occurs, in the development of which three main periods are distinguished: the pre-bacteriological, bacteriological and modern stage, which determines the population approach when studying a diverse pathology. The transformations taking place in epidemiology contribute to the convergence of this science with clinical medicine, which should bring this preventive medicine to a higher level of development. Epidemiology in the post-classical period of science can be expected to move to a new stage of its development, which will be based on an interdisciplinary generalization of infectious and non-infectious pathology.