OBESITY. PHENOTYPES AND COMORBIDITY IN THE EARLY STAGES OF THE CARDIOMETABOLIC CONTINUUM

NURIEVA ALBINA R., ORCID ID: 0000-0001-7518-0964; Scopus Author ID: 57225888886; RSCI Author ID: 1159560; Assistant Professor at the Department of Primary Care and General Practice, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. Tel. +7-987-239-17-54. Е-mail: albina-rashidovna@mail.ru

SINEGLAZOVA ALBINA V., ORCID ID: 0000-0002-7951-0040; Scopus Author ID: 55001894700; RSCI Author ID: 629346; Dr. sc. med., Professor, Head at the Department of Primary Care and General Practice, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. E-mail: sineglazovaav@mail.ru

Abstracts. Introduction. The increase in the total number of obese individuals worldwide, particularly in Russia, a deeper understanding of adipose tissue metabolism, the emergence of new methods to identify it, the younger age of patients with increased body weight, and the need for developing evidence-based preventive strategies for obesity- related comorbid diseases determine the importance of studies in this area. Aim. The aim of the study was to review medical literature containing information on different types of obesity and their role in formation of comorbidity at the initial stages of the cardiometabolic continuum. Materials and Methods. Review and analysis of articles published between 2013-2024 (PubMed, eLibrary, Google Scholar, and ResearchGate) devoted to the study of heterogeneity of adipose tissue and its association with the early formation of obesity-related comorbidities. Results and Discussion.Complex pathogenic mechanisms for development of certain somatic pathologies in general, abdominal, and visceral obesity are observed due to the heterogeneity of adipose tissue. To date, it has been shown that general obesity mostly associated with the development of arterial hypertension, gastroesophageal reflux disease, osteoarthritis, obstructive sleep apnea mainly through mechanical effects, and visceral obesity is associated with the development of dyslipidemia, prediabetes, arterial hypertension, gastroesophageal reflux disease diseases, steatosis of the liver and pancreas, osteoarthritis, obstructive sleep apnea, as manifestations of the influence of adiposopathy. Number of diseases and severity of comorbidity increases in individuals with the simultaneous presence of general, abdominal, and visceral obesity. In individuals with the simultaneous presence of general, abdominal and visceral obesity, the number of diseases and the severity of comorbidity increases. Conclusions. Literature analysis demonstrated the need for a differentiated approach to both identifying the type of obesity and the comorbidity associated with it. Further study of the characteristics of comorbidity status in various obesity phenotypes may be useful for developing personalized, evidence-based prevention strategies.

REFERENCES

UDC 616.1

 CARDIORENOMETABOLIC CONTINUUM IN CEREBROVASCULAR DISEASES

REBROVSKAYA MARIA M., ORCID ID: 0000-0000-3456-789X; Graduate student, Teaching Assistant at the Department of Therapy and Occupational Diseases, Ulyanovsk State University, 42 Leo Tolstoy str., 432017 Ulyanovsk, Russia; Physician at the Adult Day Health Rehabilitation Center at the St. Andrew the Apostle the First-Called City Clinical Hospital, 1a Kiyevsky Boulevard, 432059 Ulyanovsk, Russia. E-mail: rebrovskayamary@mail.ru

 ANALYSIS OF INSTRUMENTAL EXAMINATIONS IN SILENT MYOCARDIAL ISCHEMIA AND ANGINA PECTORIS PATIENTS WITH AND WITHOUT DIABETES MELLITUS

ABDRAHMANOVA ALSU I., ORCID ID: 0000-0003-0769-3682; SCOPUS Author ID: 57192296744, Cand. sc. med., Associate Professor, Department of Internal Diseases, Institute of Biology and Fundamental Medicine, Kazan Federal University, 74 Karl Marx str., 420012 Kazan, Russia; Physician at the Interregional Clinical Diagnostic Center, 12а Karbyshev str., 420089 Kazan, Russia. E-mail: alsuchaa@mail.ru

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 NON-ALCOHOLIC FATTY LIVER DISEASE AND ECHOCARDIOGRAPHIC PARAMETERS IN YOUNG ADULTS WITH CARDIOMETABOLIC RISK FACTORS

ASATULLINA ZEMFIRA R., ORCID 0000-0002-0059-5804; Assistant Professor; Department of Primary Care and General Practice, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. Tel. +7-987-208-93-92. E-mail: zemfira.nigmatullina96@gmail.com

SINEGLAZOVA ALBINA V., ORCID 0000-0002-7951-0040; Dr. sc. med., Professor, Head of the Department of Primary Care and General Practice, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. Tel. +7-952-041-10-01. E-mail: sineglazovaav@mail.ru

Abstract. Introduction. Non-alcoholic fatty liver disease, the most common chronic liver disease worldwide, may alter cardiac structure and function regardless of obesity, resulting in heart failure. Therefore, the association of changes in liver steatosis indices, as integral indicators of dysmetabolic processes, with changes in echocardiographic parameters is of interest. Aim. To study echocardiographic features in nonalcoholic fatty liver disease and the relationship between hepatic steatosis indices and cardiac structural and functional parameters. Materials and Methods. This “case-control” study performed in Kazan included 142 patients (74 males and 68 females) aged 35 [31-39] years. A full clinical examination was performed, including anthropometry, laboratory work-up, liver ultrasonography, and echocardiography. Non-alcoholic fatty liver disease–liver fat score, hepatic steatosis, and triglyceride and glucose indices were calculated. Data were processed using IBM SPSS Statistics 26. Results and Discussion. Ultrasonography revealed non-alcoholic fatty liver disease in 10.2% of individuals. Increased liver steatosis indices were observed in 64.8% of subjects. We found a simultaneous increase in two indices in 40.3%, and in all three indices in 14% of cases. In patients with non-alcoholic fatty liver disease, in contrast to obese subjects, we observed higher left ventricular myocardial mass (p=0.013), left atrial volume (p=0.033), end-diastolic dimension (p=0.016), end-systolic volume (p=0.022), and a trend towards higher left atrial dimension (p=0.084), interventricular septal thickness (p=0.076), end-diastolic volume (p=0.092), and lower left ventricular ejection fraction (p=0.017). The hepatic steatosis index and triglyceride and glucose index correlated with the cardiac structural and functional parameters (rs=0.176-0.424; p=0.000-0.039). Binary logistic regression demonstrated that higher hepatic steatosis index increased the likelihood of having a high normal left ventricular myocardial mass and high normal stroke volume, while an increase in triglyceride and glucose index was associated with a decrease in stroke volume (R2=0.132; p=0.000). Conclusions. The presence of nonalcoholic fatty liver disease in young adults with cardiometabolic risk factors is associated with changes in cardiac structural and functional parameters. Higher hepatic steatosis index increases the likelihood of a high normal left ventricular myocardial mass and high normal stroke volume, whereas an increase in triglyceride and glucose index increases the likelihood of low normal stroke volume.

Keywords: nonalcoholic fatty liver disease, liver steatosis indices, triglyceride and glucose index, hepatic steatosis index, insulin resistance.

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6. Pafili K, Roden М. Nonalcoholic fatty liver disease (NAFLD) from pathogenesis to treatment concepts in humans. Mol Metab. 2021; 50: 101–122. DOI: 10.1016/j.molmet.2020.101122

 ASSESSING THE EFFECT OF GLYCEMIC LEVELS ON THE RENAL FUNCTION BY THE ESTIMATED GLOMERULAR FILTRATION RATE (ESSE-RF2 STUDY DATA)

VIKTOROVA INNA A., ORCID ID: 0000-0001-8728-2722, Scopus Author ID 6603111511, Dr. sc. med., Professor, Head of the Department of Policlinic Therapy and Internal Diseases, Omsk State Medical University, 12 Leninа str, 644099 Omsk, Russia; Chief Consultant in Therapy and General Medicine (Family Medicine) of the Ministry of Health of the Omsk region. Tel.: +7 9069900907. Е-mail: vic-inna@mail.ru

MOISEEVA MARINA V., ORCID ID: 0000-0003-3458-9346, Cand. sc. med., Associate Professor at the Department of Policlinic Therapy and Internal Diseases, Omsk State Medical University, 12 Lenina str., 644099, Omsk, Russia. Tel.: +79136074342. Е-mail: lisnyak80@mail.ru

KUTSIN IVAN YU., ORCID ID: 0009-0003-9613-0896; Student, Omsk State Medical University, 12 Lenin str., 644099, Omsk, Russia. E-mail: imaganate.dark@gmail.com

SHIRLINA NATALYA G., ORCHID ID: 0000-0003-3523-9997, Cand. sc. med., Associate Professor at the Department of Epidemiology, Omsk State Medical University, 12 Lenina str., 644099, Omsk, Russia. E-mail: shirlina.n@yandex.ruBILEVICH OLGA A., ORCID ID: 0000-0003-2583-5648, Cand. sc. med., Associate Professor at the Department of Internal Diseases Propaedeutics, Omsk State Medical University, 12 Lenina str., 644099, Omsk, Russia. E-mail: bilewich@mail.ru

STASENKO VLADIMIR L., ORCHID ID: 0000-0003-3164-8734, Dr. sc. med., Professor, Dean of the Faculty of Medicine and Prevention, Head of the Department of Epidemiology, Omsk State Medical University, 12 Lenina str., 644099, Omsk, Russia. E-mail: vlstasenko@yandex.ru

IVANOVA DARYA S., ORCID ID: 0000-0003-3668-1023, Cand. sc. med., Associate Professor at the Department of Policlinic Therapy and Internal Diseases, Omsk State Medical University, 12 Lenina str., 644099, Omsk, Russia. E-mail: darja.ordinator@mail.ru

PETRENKO MARINA V., ORCID ID: 0009-0003-2077-0942, Student, Omsk State Medical University, 12 Lenina str., 644099, Omsk, Russia. E-mail: marin.petrenko75@gmail.com

Abstract. Introduction. More than one third of people (aged 60 and above) have signs of chronic kidney disease, which requires monitoring of the estimated glomerular filtration rate (eGFR) due to the low-symptomatic course of earlier (C1-C3A) stages of chronic kidney disease. The relevant issue is: What fasting plasma glucose levels reflect the prediabetes stage more accurately and earlier damage to target organs, specifically kidneys. Aim. The aim of the study was to determine the relationship between the eGFR and the glycemic levels in a representative sample of the Omsk Region (ESSE-RF2 study). Materials and Methods. A random population sample was analyzed in the Omsk Region (n=1506), aged 25-64. Glomerular filtration rate was estimated using the CKD-EPI formula for the year 2021. The test subjects are divided into four groups by glucose levels: The levels of 5.6 to 6.0 mmol/l were in 176 people (1); 6.1 to 6.9 mmol/l in 100 people (2); 7.0 mmol/l and more in 86 people (3); and under 5.6 mmol/l in 1,144 people (4). Data distribution was evaluated according to the Shapiro-Wilk criterion, the statistical significance was assessed using the Welch ANOVA approach, and differences in groups were evaluated using the Tukey test. Results and Discussion.In Welch ANOVA, the F-statistic was 27.3 at p<0.05 – statistically significant differences were detected in the estimated glomerular filtration rates among the groups depending on glycemia. Differences in the estimated glomerular filtration rates relate to the normoglycemia group compared to the three hyperglycemia groups, starting from 5.6 mmol/l. Test Tukey revealed a statistically significant decrease in the estimated glomerular filtration rates among the three groups in terms of glycemia, compared with the normoglycemia group: 4-3, 4-2, and 4-1. When comparing groups 2-3 and 1-2 in pairs, there were no differences in the degree of changes in the estimated glomerular filtration rates based on glucose levels. Discussing a high filtration level – above 120 ml/min/1.7 m2 by the estimated glomerular filtration rate in 1.16–2.84% of individuals with various levels of hyperglycemia suggests renal hyperfiltration as the earliest stage of renal dysfunction. Conclusions. Statistical data analysis emphasizes the relationship between changes in the estimated glomerular filtration rate in hyperglycemia, starting with the plasma glucose level of 5.6 mmol/l or higher. The criterion of fasting hyperglycemia starting from 6.1 mmol/l is overstated, since that of hyperglycemia starting from 5.6 mmol/l reflects kidney damage more accurately.

Keywords: hyperglycemia, estimated GFR, renal hyperfiltration, ESSE-RF2.

For reference: Viktorova IA, Moiseeva MV, Kutsin IY, et al. Assessing the effect of glycemic levels on the renal function by the estimated glomerular filtration rate (ESSE-RF2 study data). The Bulletin of Contemporary Clinical Medicine. 2024; 17 (4): 48-56. DOI: 10.20969/VSKM.2024.17(4).48-56.

 DIETARY RECOMMENDATIONS FOR CARDIOVASCULAR PATHOLOGY

MAMEDOV ALI N., ORCID ID: 0009-0006-6173-0201, Student, Kazan State Medical University, 420012, 49 Butlerov str., Kazan, Russia. Tel.: +7(939)3692094. Е-mail: alimamedov-2012@mail.ru

ABITOVA ALINA A., ORCID ID: 0009-0000-6974-5826, Student, Kazan State Medical University, 420012, 49 Butlerov str., Kazan, Russia. Tel.: +7(999)1630621. Е-mail: alina.abitova2017@yandex.ru

AMIROV NAIL B., ORCID ID: 0000-0003-0009-9103; SCOPUS Authоr ID: 7005357664; Dr. sc. med., Professor at the Department of Outpatient Medicine and General Practical Medicine, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. Deputy Chief Physician for Research, Primary Healthcare Unit of the Ministry of Internal Affairs of the Russian Federation in the Republic of Tatarstan, 132 Orenburg Trakt str., 420059 Kazan, Russia. Tel.: +7(843) 291-26-76. E-mail: namirov@mail.ru

Abstract. Introduction. Dietary therapy is one of the primary and essential methods of non-drug therapy. In this regard, the diet should correspond to energy and physiological needs of the body. However, not all dietary practices are available due to the limited choice of the food basket due to the climate in Russia. Aim. Based on the analysis of the product range of the most common diets used to treat cardiovascular pathology, to develop dietary recommendations relevant to the climatic conditions in Central Russia. Materials and Methods. Domestic and foreign literary sources were analyzed, containing information on nutritional support in the clinic of internal diseases over the past 10 years. The literature was searched in the eLibrary, Cyberleninka, and PubMed databases by the following keywords: diet, cardiovascular diseases, diet therapy, pathology. Results and Discussion. Currently, various dietary patterns are gaining popularity. We analyzed the product range of the leading diets, including the Mediterranean and Scandinavian types of nutrition, as well as the paleolithic diet and the DASH (Dietary Approaches to Stop Hypertension) diet. Conclusions. The dietary nutrition patterns presented in this study comply with the healthy diet guidelines, but they have some modifications. The effectiveness of the dietary practices proposed is demonstrated by research results and meta-analysis data. Therefore, based on the analysis of the product range of the above-mentioned diets, dietary recommendations were developed that correspond to the climatic conditions of Central Russia.

Keywords: diet, cardiovascular diseases, dietary therapy, pathology.

For reference: Mamedov AN, Abitova AA, Amirov NB. Dietary recommendations for cardiovascular pathology. The Bulletin of Contemporary Clinical Medicine. 2024; 17 (4): 57-64. DOI: 10.20969/VSKM.2024.17(4).57-64.

 CARDIOVASCULAR AND KIDNEY ASSESSMENT IN NON-ALCOHOLIC FATTY LIVER DISEASE IN YOUNG ADULTS

PANKOVA EKATERINA D., ORCID ID: 0000-0002-6301-7630; Postgraduate Student of the Department of Faculty Therapy, South Ural State Medical University, 64 Vorovsky str., 454092 Chelyabinsk, Russia. E-mail: katerinachelsma@yandex.ru

CHULKOV VASILIY S., ORCID ID: 0000-0002-0952-6856, Associate Professor at the Department of Internal Diseases, Yaroslav-the-Wise Novgorod State University, 41 Bolshaya Sankt-Petersburgskaya str., 173003 Veliky Novgorod, Russia. E-mail: vschulkov@rambler.ru

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11. Чулков В.С., Сумеркина В.А., Абрамовских О.А., Чулков В.С. Частота неалкогольной жировой болезни печени у молодых пациентов с абдоминальным ожирением на фоне артериальной гипертензии // Экспериментальная и клиническая гастроэнтерология. – 2014. – No 11(111). – С. 42-45. [Chulkov VS, Sumerkina VA, Abramovskikh OS, Chulkov VS. Chastota nealkogol’noy zhirovoy bolezni pecheni u molodykh patsiyentov s abdominal’nym ozhireniyem na fone arterial’noy gipertenzii [Prevalence of nonalcoholic fatty liver disease in young patients with abdominal obesity and hypertension]. Eksperimental’naya i klinicheskaya gastroenterologiya [Experimental and Clinical Gastroenterology]. 2014; (11): 42-45. (In Russ.)].

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 CARDIOMETABOLIC PROFILE IN RELATION TO CMDS STAGING IN YOUNG ADULTS

SINEGLAZOVA ALBINA V., ORCID ID: 0000–0002–7951–0040; Dr. sc. med., Professor, Head of the Department of Primary Care and General Practice, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. Tel. +7 (952) 041–10–01. E-mail: sineglazovaav@mail.ru

PARVE SWAPNIL D., ORCID ID: 0000–0002–8069–4350; Cand. sc. med., Assistant Professor at the Department of Primary Care and General Practice, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. Tel. +7 (987) 414–92–28. E–mail: drswapnilparve@gmail.com

FAKHRUTDINOVA ALIYA S., ORCID ID: 0000–0001–7518–0964; Assistant Professor at the Department of Primary Care and General Practice, Kazan State Medical University, 49 Butlerov str., 420012, Kazan, Russia. Tel. +7–987–230–46–70. E–mail: aliyazak@mail.ru

KIM TAISIYA YU., ORCID ID: 0000–0003–2370–2972; Cand. sc. med., Associate Professor at the Department of Primary Care and General Practice, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. Tel. +7–917–241–71–69. E–mail: tais_ariana@mail.ru

NURIEVA ALBINA R., ORCID 0000–0001–7518–0964; Assistant Professor at the Department of Primary Care and General Practice, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. Tel. +7–987–239–17–54. E–mail: albina–rashidovna@mail.ru

ASATULLINA ZEMFIRA R., ORCID 0000–0002–0059–5804; Assistant Professor at the Department of Primary Care and General Practice, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. Tel. +7–987–208–93–92. E–mail: zemfira.nigmatullina96@gmail.com

MUSTAFINA GUZEL R., ORCID ID: 0009–0004–7511–4173; Assistant Professor at the Department of Primary Care and General Practice, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. Tel. +7 (904) 674–96–64. E–mail: chulpan.gimadieva@mail.ru

NURMIYEVA LILIYA S., ORCID ID: 0009–0003–0836–8774; Assistant Professor at the Department of Primary Care and General Practice, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia; Director of Consultative Diagnostic Center of Aviastroitelny City District of Kazan, Russia; 10 Lukina str, 420127 Kazan, Russia. Tel. +7 (937) 771–37–71. E–mail: spilka_nls@mail.ru

Abstract. Introduction. The burden of cardiovascular disease, diabetes mellitus, and the associated mortality remains high. One classification system that predicts the development of cardiovascular events and type 2 diabetes mellitus is Cardiometabolic Disease Staging (CMDS). The study of new cardiometabolic profile parameters is relevant in the context of their association with residual cardiovascular risk. The aim of the study was to evaluate the cardiometabolic profile, including extended parameters, in young adults, while taking into account the CMDS. Materials and Methods.185 male and female subjects aged 35.0 [30.0–39.0] years were examined. The participants were divided into groups according to the CMDS classification: Stage 0, metabolically healthy; Stage 1 (low risk), one or two risk factors (RFs) other than prediabetes; Stage 2 (intermediate risk), presence of ≥3 risk factors or prediabetes; Stage 3 (high risk), presence of ≥3 risk factors and prediabetes. The study examined visceral adiposity index, visceral fat level, insulin resistance, leptinemia, hyperuricemia, glomerular filtration rate, C–reactive protein, and N–terminal brain natriuretic peptide concentrations. The data were processed in SPSS Statistics 26. Results and Discussion. The cardiometabolic profile demonstrated unfavorable alterations with the progression of CMDS stages. Across the spectrum from CMDS 0 to CMDS 3, we observed a significant rise in the prevalence of abdominal obesity (0% to 100%, p<0,001), body mass index ≥25 kg/m2 (16.2% to 100%, p<0.001), and excess visceral fat level (0% to 23.8%, p<0.001). Simultaneously, the prevalence of hypercholesterolemia demonstrated a significant rise (24.3% to 52.4%, p=0.025), as did elevated low–density lipoprotein cholesterol (32.4% to 76.1%, p=0.014), insulin resistance (2.7% to 66.7%, p<0.001), leptinemia (45.9% to 90.5%, p=0.009), C–reactive protein (2.7% to 57.1%, p<0.001) and hyperuricemia (16.2% to 61.9%, p<0.001). The median values of these parameters also increased. Conclusions. Our data confirm the simultaneous increase in both the quantity and intensity of risk factors, manifestations of adiposopathy associated with increasing residual cardiovascular risk. Our results substantiate the feasibility of using the CMDS classification at the stage of primary prevention of cardiometabolic diseases to identify groups with the most significant metabolism disorders of lipid, carbohydrate and purine metabolism in young adults.

Keywords: CMDS, cardiometabolic risk factors, young age, obesity, insulin resistance, prediabetes.

For reference: Sineglazova AV, Parve SD, Fakhrutdinova AS, et al. Cardiometabolic profile in relation to CMDS staging in young adults. The Bulletin of Contemporary Clinical Medicine. 2024; 17 (4): 82-92. DOI: 10.20969/VSKM.2024.17(4).82-92.

 OBESITY AND ADHERENCE TO TREATMENT ACCORDING TO THE QAA-25 QUESTIONNAIRE IN A PROSPECTIVE FOLLOW-UP STUDY

FAKHRUTDINOVA ALIYA S., ORCID ID: 0000-0001-7518-0964; Assistant Professor at the Department of Primary Care and General Practice, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. Tel. (987) 230-46-70. E-mail: aliyazak@mail.ru

SINEGLAZOVA ALBINA V., ORCID ID: 0000-0002-7951-0040; Dr. sc. med., Professor, Head of the Department of Primary Care and General Practice, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. Tel. +7 (952) 041-10-01. E-mail: sineglazovaav@mail.ru

Abstract. Introduction. Obesity is a modifiable cardiometabolic risk factor and a comorbidity-associated disease. Hence, to improve the effectiveness of individual preventive programs, it is important to study the features of treatment adherence in young adults. Aim of the study was to analyze the changes in various types of obesity considering the adherence to treatment in young adults. Materials and Methods. This prospective study (Me=18.6[17.4-20.1] months) enrolled 94 (45 male (47.9%) and 49 female (52.1%)) patients aged Me=33[28.7-38] years. The presence of overweight, general and abdominal obesity, and excess visceral fat level was analyzed. Treatment adherence was assessed using the quantitative assessment of the adherence (QAA-25) questionnaire. Overall adherence to treatment, adherence to lifestyle modification, pharmacotherapy, and medical follow-up were determined. A level of ≤49% was considered low; 50-74% as medium, and ≥75% as high. IBM SPSS Statistics 26 was used for statistical analyses. Results and Discussion. We found an increasing trend in the incidence of abdominal obesity and excess visceral fat levels during follow-up. In the study cohort, majority had low adherence levels: overall adherence to treatment – 64.9%(n=61), adherence to lifestyle modification – 53.2(n=50), adherence to pharmacotherapy – 64.9%(n=61), and adherence to medical support – 47.9% (n=45). In all types of low adherence levels, there was an increase in the incidence of abdominal obesity due to increased waist circumference and waist-to-hip ratio. Likewise, the odds of higher excess visceral fat levels increased by 1.15-fold with low overall treatment adherence; 1.19-fold with low adherence to lifestyle modification and pharmacotherapy; and 1.49-fold in those with low adherence to medical support. The odds of becoming overweight and obese increased in those with low and medium adherence to lifestyle modification by 6.22 and 10.11 times, respectively. Conclusions. The adherence level according to the QAA-25 scores in young adults was low. During follow-up in all types of low adherence levels, the incidence of abdominal obesity and the odds of excess visceral fat level increased. During 18-month prospective follow-up, the cardiometabolic profile significantly worsened in patients with low adherence. Developing personalized preventive programs considering the level of patient adherence may influence the effectiveness of treatment and improve metabolic health.

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 NEUROVISUALIZATION OF NEUROVASCULAR CONFLICT

ABDULLAYEVA MUBORAK B., ORCID ID: 0000-0001-7197-5604, PhD, Associate Professor at the Department of Nervous Diseases, Faculty of Folk Medicine, Tashkent State Dental Institute, 103 Makhtumkuli str., 100047 Tashkent, Uzbekistan. E-mail: muborakabdullayeva14@gmail.com

INOYATOVA SITORA O., ORCID ID: 0009-0004-1385-4416, PhD, Associate Professor at the Department of Nervous Diseases, Faculty of Folk Medicine, Tashkent State Dental Institute, 103 Makhtumkuli str., 100047 Tashkent, Uzbekistan. E-mail: sitorainoyatova03@gmail.com

YODGOROVA UMIDA G., ORCID ID: 0000-0002-7846-4417, PhD, Associate Professor at the Department of Nervous Diseases, Faculty of Folk Medicine, Tashkent State Dental Institute, 103 Makhtumkuli str., 100047 Tashkent, Uzbekistan. E-mail: umka8587@mail.ru

HIKMATULLAEVA SHAKHNOZA SH., ORCID ID: 0000-0003-4500-1798, PhD, Assistant Professor at the Department of Nervous Diseases, Faculty of Folk Medicine, Tashkent State Dental Institute, 103 Makhtumkuli str., 100047 Tashkent, Uzbekistan. E-mail: Shaxnoza0223@gmail.com

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 PERFUSION COMPUTED TOMOGRAPHY: NEW HORIZONS IN DIAGNOSING DISEASES OF THE PANCREAS

DJURAEVA NIGORA M., ORCID ID: 0000-0002-2232-8264, Dr. sc. med., Head of the Department of Computed and Magnetic Resonance Imaging, Republican Specialized Scientific and Practical Center for Surgery named after Academician V. Vakhidov, Uzbekistan, 10 Kichik Khalka Yuli str., Tashkent, Uzbekistan. E-mail: nika.kt@rambler.ru

IBADOV RAVSHAN A., ORCID ID: 0000-0002-0992-0802, Dr. sc. med., Professor, Head of the Emergency Department, Republican Specialized Scientific and Practical Center for Surgery named after Academician V. Vakhidov, 10 Kichik Khalka Yuli str., Tashkent, Uzbekistan. E-mail: tmsravshan@mail.ru

IBRAGIMOV SARDOR Kh., ORCID ID: 0000-0003-2876-411X, Cand. sc. med, Senior Researcher at the Department of Reanimation and Intensive Care, Republican Specialized Scientific and Practical Center for Surgery named after Academician V. Vakhidov, 10 Kichik Khalka Yuli str., Tashkent, Uzbekistan. E-mail: dr.sardor.ibragimov@gmail.com

ABDUKHALIMOVA KHANUM V., ORCID ID:0000-0002-3294-4183, Cand. sc. med, Radiologist, Junior Researcher at the Department of Computed and Magnetic Resonance Imaging, Republican Specialized Scientific and Practical Center for Surgery named after Academician V. Vakhidov, 10 Kichik Khalka Yuli str., Tashkent, Uzbekistan. E-mail: xanummuzik@yandex.ru

AKILOVA GULNARA K., ORCID ID: 0009-0007-9421-5529, Applicant for the degree of Cand. sc. med., Employee at the Department of Computed and Magnetic Resonance Imaging, Republican Specialized Scientific and Practical Center for Surgery named after Academician V. Vakhidov, 10 Kichik Khalka Yuli str., Tashkent, Uzbekistan. E-mail: lolita_yunusova@mail.ru

Abstract. Introduction. According to the World Health Organization, the most common disease of the pancreas is acute pancreatitis, which can lead to the development of pancreatic necrosis. In this regard, early diagnosis and assessment of the pancreatic necrosis risk development are of paramount importance for choosing adequate treatment approaches and improving outcomes for patients. Radiological research methods have become the “gold” standard in clinical practice for the primary diagnosis of pancreatic diseases. Contrast-enhanced computed tomography has traditionally been used to visualize the pancreas and assess the extent of inflammation and necrotic changes. However, standard computed tomography has limitations in assessing tissue perfusion, which is an important aspect of the pathophysiology of acute pancreatitis. Perfusion computed tomography of the pancreas has become a colossal breakthrough in radiation imaging, has become widespread as a method that allows the quantitative assessment of blood supply to the pancreas, including information about microcirculation, and it can be used for the early detection of ischemic changes that precede tissue necrosis in the pancreas. Aim. To study the capabilities of perfusion computed tomography and computed tomography angiography of the pancreas for evaluating the area of pancreatic necrosis in acute pancreatitis, with the aim of improving diagnosis and planning treatment measures to minimize the consequences and increase patient survival. Materials and Methods. A single-center examination was carried out on 42 patients (18 women, 24 men, mean age 38±2 years) with suspected acute pancreatitis. All patients underwent perfusion computed tomography within the first 3 days; over the next 3-5 days, computed tomography angiography of the pancreas was performed with bolus intravenous contrast to confirm the development of necrotic changes. Results and Discussion. After performing perfusion computed tomography within the first 3 days from the onset of symptoms, areas of ischemic damage to the pancreas tissue were identified in 16 (38.1%) out of 42 patients. After computed tomography angiography, the development of necrotic changes was confirmed in 7 patients (16.7%). The localization of the necrosis zone detected in computed tomography coincided with the ischemic zones on the color hemodynamic maps of perfusion computed tomography.

Keywords: CT perfusion, CT angiography, pancreas, acute pancreatitis, pancreatic necrosis, visualization, diagnostics.

For reference: Djuraeva NM, Ibadov RA, Ibragimov SK, et al. Perfusion computed tomography: new horizons in diagnosing diseases of the pancreas. The Bulletin of Contemporary Clinical Medicine. 2024; 17 (4): 108-116.DOI: 10.20969/VSKM.2024.17(4).108-116.

 COMBINED ACTIVE AND PASSIVE KINESIOTHERAPY IN REHABILITATION AFTER COVID-19 OF VARYING SEVERITY

MINASOV BULAT SH., ORCID ID: 0000-0002-1733-9823, Dr. sc. med., Professor, Head of the Department of Traumatology and Orthopedics with the Course of Postgraduate Education Institute, Bashkir State Medical University, 3 Lenin str., 450008 Ufa, Russia. Phone: +7-347-255-76-66. E-mail: minasov@rambler.ru

ZULKARNEEV RUSTEM H., ORCID ID: 0000-0002-9749-7070, Dr. sc. med., Professor at the Department of Internal Medicine (Propaedeutics), Bashkir State Medical University, 3 Lenin str., 450008 Ufa, Russia. E-mail: zurustem@mail.ru

MINASOV TIMUR B., ORCID ID: 0000-0003-1916-383, Dr. sc, med., Professor at the Department of Traumatology and Orthopedics with the Course of Postgraduate Education Institute, Bashkir State Medical University, 3 Lenin str., 420008 Ufa, Russia. E-mail: m004@yandex.ru

VALISHIN DAMIR A., ORCID ID: 0000-0002-1811-9320, Dr. sc, med., Professor, Head of the Department of Infectious Diseases with the Course of Postgraduate Education Institute, Bashkir State Medical University, 3 Lenin str., 450008 Ufa, Russia. E-mail: infecti4@mail.ru

MINASOV ISKANDER B., ORCID ID: 0000-0002-1982-1365. Cand. sc. med., Associate Professor, Department of Medical Rehabilitation and Sports Medicine, Bashkir State Medical University, 3 Lenin str., 450008 Ufa, Russia. E-mail:m01b@ya.ru

EVGRAFOV IGOR O., Assistant Professor, Department of Traumatology and Orthopedics with the Course of Postgraduate Education Institute, Bashkir State Medical University, 3 Lenin str., 450008 Ufa, Russia. E-mail: help@medrocket.ru

LASYNOVA GULNAZ H., ORCID ID: 0000-0001-5193-2164, Head of the Medical Rehabilitation Department, University Hospital, Bashkir State Medical University, E-mail: lasynova1987@mail.ru

NAZYROVA REZEDA M., Physician, Medical Rehabilitation Department, University Hospital, Bashkir State Medical University, 2 Shafiev str., 450096 Ufa, Russia. E-mail: latipova.rezeda2016@yandex.ru

Abstract. Introduction. Rehabilitation is necessary to restore the quality of life of post-COVID-19 patients. Aim of the study is to evaluate effectiveness and safety of the rehabilitation using combined active and passive kinesiotherapy after COVID-19 of varying severity. Materials and Methods. Study design: comparative, prospective, open. The study involved 17 patients after moderate COVID-19 (M_COV19) and 21 patients after severe COVID-19 (S_COV19). The 2-week rehabilitation course consisted of 6 active and 10 passive kinesiotherapy procedures. Active kinesiotherapy included breathing training and physical exercises. Passive kinesiotherapy was carried out using the ORMED-KINESO mechanotherapy device. Passive rhythmic flexion-extension movements were performed in the patient’s thoracic spine with a comfortable frequency of 12-20/min within a 10-minute procedure. The rehabilitation effect was assessed using Baseline and Transition Dyspnea Indices (BDI-TDI), spirography, and the 6-minute walk test (6-MWT). For spirography, individual predicted normal values were calculated using the Global Lung Function Initiative (GLI) equations, and the relative predicted values were calculated by the formula: %predicted = measured value/predicted normal value*100%. The data are given as Median (Quartile1, Quartile3), while changes are presented as Median [95% confidence interval]. Results and Discussion. At baseline, the patients suffered from dyspnea. BDI was 9(6;9) in M_COV19 and 8(6;9) in S_COV19, p=0.89. All patients noted a decrease in dyspnea after rehabilitation. TDI was +6(3.7;6.3) and +4(3.7;6.0), respectively, p=0.53. Spirography showed restrictive limitation of pulmonary function. Vital capacity (VC) was 72.0(67.3;82.3)%predicted in M_COV19 and 59.0(47.0;68.7)%predicted in S_COV19, p<0.001. After rehabilitation, the increase in VC was +6.5[3;10.5]%predicted, p=0.001, and +7.0[3.0;14.0]%predicted, p=0.001, respectively, no difference between groups, p=0.88. Only in M_COV19, forced vital capacity(FVC) increased by +5.5[2.0;10.5]%predicted, p=0.002, and 1st-second forced expiratory volume (FEV ) increased by +10.0[3.5;23.0]%predicted, p=0.003. After rehabilitation the 6-MWT distance increased from 364(332;431)m to 400(351;495)m, p=0.001, in M_COV19 and it increased from 322(238;347)m to 356(322;381)m, p=0.001, in S_COV19. 6-MWT median gain was +43[26;74]m and +37[21;59] m, respectively, no significant difference, p=0.56. Conclusions. Combined active and passive kinesiotherapy demonstrated comparable rehabilitation effectiveness and safety in patients after both moderate and severe COVID-19. The rehabilitation course reduced dyspnea and increased physical performances in both groups. Pulmonary function improvement was more significant in patients after moderate СOVID-19 compared to severe COVID-19.

Keywords: COVID-19, rehabilitation, kinesiotherapy

For reference: Minasov BSh, Zulkarneev RH, Minasov TB, et al. Combined active and passive kinesiotherapy in rehabilitation after COVID-19 of varying severity. The Bulletin of Contemporary Clinical Medicine. 2024; 17 (4): 117-126. DOI: 10.20969/VSKM.2024.17(4).117-126.

UDC:7696.332-796.422.12/16:796.92-519.63

DOI: 10.20969/VSKM.2024.17(4).127-134

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 EFFECTIVENESS OF TYMPANOSTOMY TUBES IN CHILDREN WITH AUDITORY TUBE DYSFUNCTION

USMANOVA NILUFAR A., ORCID ID: 0009-0004-6281-5093; Postgraduate Student at the Department of Otorhinolaryngology, Tashkent State Dental Institute, 103 Makhtumkuli street, 100047 Tashkent, Uzbekistan. E-mail: lolita_yunusova@mail.ru

MAKHKAMOVA NIGORA E., ORCID ID: 0000-0003-0064-9806; Dr. sc. med., Professor at the Department of Otorhinolaryngology, Tashkent State Dental Institute, 103 Makhtumkuli street, 100047 Tashkent, Uzbekistan. E-mail: lor_kaf@mail.ru

BALTABAEV OLIMJON K., ORCID ID: 0000-0002-2344-9666; Doctoral Student at the Department of Otorhinolaryngology, Tashkent State Dental Institute, 103 Makhtumkuli street, 100047 Tashkent, Uzbekistan. E-mail: lolita_yunusova@mail.ru

ABDUVALIEV ABDUVORIS A., ORCID ID: 0009-0007-0797-2303; Postgraduate Student at the Department of Pediatric Maxillofacial Surgery, Tashkent State Dental Institute, 103 Makhtumkuli street, Yashnabad District, 100047 Tashkent, Uzbekistan. E-mail: info@tsdi.uz

Abstract. Introduction. In the modern world, we observe the rapid development pace of surgical technologies, on the one hand, and the existing eco-climatic factors that contribute to the increase in infectious and inflammatory diseases among the child population, on the other hand. All this contributes to the fact that surgical treatment of a pathology appears more effective along with conservative treatment. Aim of the study was to investigate the effectiveness of installing tympanostomy tubes in pediatric patients with symptoms of exudative otitis media and auditory tube dysfunction.Materials and Methods. The study included 38 children with symptoms of exudative otitis media and the auditory tube dysfunction. Research methods included endoscopic assessment of the nasal cavity and ears, tympanometry, and the 3D x-ray examination of the paranasal sinuses. All data obtained in the study was entered into Excel summary tables. After dividing the data into comparison groups, the group means and their standard errors were calculated. Dynamic comparisons were performed using paired Student’s t-test. Results and Discussion. In patients with bilateral shunting, subjective hearing recovery was observed, which was 75% of patients who could not undergo threshold audiometry; patients who underwent audiometry showed 60% complete hearing recovery and 40% recovery within 5-10 dB 1 month after surgery. Conclusions. In the group of patients with unilateral installation of shunts, it also showed high rates of hearing recovery. It is also worth noting that there are high rates of recurrence of an episode of otitis media after paracentesis without placement of tympanostomy tubes.

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 PROFESSOR RAISA SH. ABDRAKHMANOVA’S SUCCESSORS (in honor of the 100th anniversary of her birth)

MANGUSHEVA MARZIA M., ORCID ID: 0000–0002–6425–4216; Cand. sc. med., Associate Professor, Department of Advanced Internal Medicine, Kazan State Medical University, 49 Butlerova str.,420012 Kazan, Russia.
E–mail: mangushevamm@mail.ru.

SHAMSUTDINOVA NAILYA G., ORCID ID: 0000–0001–7320–0861; Cand. sc. med., Associate Professor, Department of Advanced Internal Medicine, Kazan State Medical University, 49 Butlerova str., 420012 Kazan, Russia. E–mail: ngshamsutdinova@gmail.com

ABDULGANIEVA DIANA I., ORCID ID: 0000–0001–7069–2725; Dr. sc. med., Head of the Department of Advanced Internal Medicine, Kazan State Medical University, 49 Butlerova str., 420012 Kazan, Russia. E–mail: diana_s@mail.ru

AMIROV NAIL B., ORCID ID: 0000–0003–0009–9103; SCOPUS Authоr ID: 7005357664; Dr. sc. med., Professor at the Department of Outpatient Medicine and General Practical Medicine, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. Deputy Chief Physician for Research, Medical Unit of the Ministry of Internal Affairs of the Russian Federation in the Republic of Tatarstan, 132 Orenburg Route str., 420059 Kazan, Russia. Tel.: +7 (843) 291–26–76. E–mail: namirov@mail.ru

VIZEL ALEXANDER A., ORCID ID: 0000–0001–5028–5276, Dr. sc. med., Head of the Department of Phthisiopulmonology, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. Tel.: +7 (843) 296–25–99. E–mail: lordara@inbox.ru

VOLKOVA ANASTASIA S., ORCID ID 0009–0006–9023–4186; 6th-year full–time student at the Faculty of Medicine, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. E–mail: nasvolkova@mail.ru

KURSINA VICTORIA A., ORCID ID 0009–0004–0762–4622; 6th-year full–time student at the Faculty of Medicine, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. E–mail: 357kursina@gmail.com

EFIMOVA DILYARA M., ORCID ID: 0009–0006–9103–9841; 6th-year full–time student at the Faculty of Medicine, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. E–mail: dilarusa3020@gmail.com

Abstract. Introduction. Raisa Sh. Abdrakhmanova (1923–2014) is known as an experienced therapist and teacher. Being a Doctor of Medicine, Professor, Honored Scientist of the Tatar Autonomous Soviet Socialist Republic, Winner of the State Science & Technology Award of the Republic of Tatarstan, Ms. Abdrakhmanova educated students – famous scientists, doctors, and teachers. In the late 1970s and early 1980s, in her activities, one of the most important areas was assistance in the education and training of residents, many of whom became heads of departments at the Republican Clinical Hospital in future. Her students still work as practical physicians, teach, and transfer the knowledge received from the professor to a new generation of doctors. Aim. To show the role of Professor Raisa Sh. Abdrakhmanova in the development of Kazan school of physicians. Materials and Methods. The article presents the memories of Prof. Raisa Sh. Abdrakhmanova and analyzes the further professional trajectories of her disciples and their achievements in medical profession. Results and Discussion. The article describes the key milestones in the life path of the successors of Professor Raisa Sh. Abdrakhmanova, such as professors Nail B. Amirov and Alexander A. Vizel and associate professors Marziya M. Mangusheva and Larisa K. Bombina. The article also covers the research topics and activities performed by her successors, Gulsina M. Khalfeyeva, Zuhaira N. Yakupova, Niaz A. Miftakhov, Ilyas S. Tagirov, and Rif Kh. Shafikov. Conclusions. Contribution of Professor Raisa Sh. Abdrakhmanova to the training and education of future physicians is truly invaluable. Her successors became eminent physicians and continue to transfer the knowledge acquired to the new breeds of physicians to this day.

Keywords: Professor Raisa Sh. Abdrakhmanova, successors, history of medicine, Nail B. Amirov, Alexander A. Vizel, Marziya M. Mangusheva, Larisa K. Bombina, Gulsina M. Khalfeyeva, Zuhaira N. Yakupova, Niaz A. Miftakhov, Ilyas S. Tagirov, Rif Kh. Shafikov.

For reference: Mangusheva MM, Shamsutdinova NG, Abdulganieva DI, et al. Professor Raisa Sh. Abdrakhmanova’s successors (in honor of the 100th anniversary of her birth). The Bulletin of Contemporary Clinical Medicine. 2024; 17 (4): 142-148. DOI: 10.20969/VSKM.2024.17(4).142-148.

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 IMMUNOPATHOGENESIS, ONCOGENESIS, AND PROSPECTS FOR THERAPY AND VACCINE PREVENTION OF HIV INFECTION

MOSKALEV ALEXANDR V., ORCID ID: 0009-0004-5669-7464; Dr. sc. med, Professor, Professor at the Department of Microbiology, S.M. Kirov Military Medical Academy, 6 Academician Lebedev str., 194044 St. Petersburg, Russia. Е-mail: alexmav195223@yandex.ru

GUMILEVSKY BORIS YU., ORCID ID: 0000-0001-8755-2219; SCOPUS Author ID: 6602391269; Dr. sc. med, professor, Head at the Department of Microbiology, S.M. Kirov Military Medical Academy, 6 Academician Lebedev str., 194044 St. Petersburg, Russia. Е-mail: gumbu@mail.ru

ZHESTKOV ALEXANDR V., ORCID ID: 0000-0002-3960-830Х; Dr. sc. med, Professor, Head of the Department of General and Clinical Microbiology, Immunology and Allergology, Samara State Medical University, 18 Gagarina str., 443079 Samara, Russia. Е-mail: a.v.zhestkov@samsmu.ru

ZOLOTOV MAKSIM O., ORCID ID: 0000-0002-4806-050X; Cand. sc. med., Associate Professor at the Department of General and Clinical Microbiology, Immunology and Allergology, Samara State Medical University, 18 Gagarina str., 443079 Samara, Russia. Е-mail: m.o.zolotov@samsmu.ru

FALALEEVA EVGENIYA A., ORCID ID: 0009-0005-6692-0779; Assistant Professor at the Department of General and Clinical Microbiology, Immunology and Allergology, Samara State Medical University, 18 Gagarina str., 443079 Samara, Russian Federation; E-mail: e.a.falaleeva@samsmu.ru

RESHETNIKOVA VALENTINA P., ORCID ID: 0009-0002-2910-4519; Cand. sc. med., Associate Professor at the Department of General and Clinical Microbiology, Immunology and Allergology, Samara State Medical University, 18 Gagarina str., 443079 Samara, Russia. E-mail: v.p.reshetnikova@samsmu.ru

Abstract. Introduction. Features of the immunopathogenesis of infection associated with human immunodeficiency virus type 1 is a decrease in the virus reproduction rate against the background of elevated levels of pro-inflammatory cytokines. Aim of the study is to summarize new literature data on the features of immunopathogenesis, complications and prospects for the prevention and treatment of HIV infection. Materials and Methods. Modern scientific literature sources for the years 2010–2022 were studied, dealing with the features of immunopathogenesis, tumor-associated complications, and concomitant opportunistic infections in HIV infection. Results and Discussion. In infected patients with no etiotropic treatment, the expression of interferon-stimulated genes remains elevated throughout the course of the infection. The main proteins of the host cell are shown that bind to the proteins of the capsid of human immunodeficiency virus type 1: Peptidyl-prolyl-isomerase cyclophilin A, cleavage and polyadenylation factor 6, components of the nucleus pores. The effect provided by each host cell protein on the protein-nucleic complex stability varies and depends on the nature of the target cell. Mutants of the human immunodeficiency virus type 1, in which the protein-nucleic complex is not completely covered by the capsid coat, are defective for reproduction. During adaptation, such strains acquired the ability to evade neutralization by the tetherin proteins and myxovirus resistance. Moreover, at all stages of infection, immunoglobulin subtypes G1 play a dominant role, causing antibody-dependent cellular and complement-dependent cytotoxicity. The mechanisms of oncogenesis caused by the human immunodeficiency virus are different than those in other retroviral infections. Human immunodeficiency virus kills target cells and does not contribute to their unlimited proliferation typical of oncogenesis. Uncontrolled proliferation, by any mechanism, can lead to chromosomal changes necessary for cell transformation and to malignant neoplasms. Conclusions. The prospects of modern biotechnology are associated with the possibilities of direct gene editing, with the help of which CD4 + T cells and hematopoietic stem cells are modified and become HIV-I infection resistant. The viral genome can be inactivated by directly targeting HIV-1 LTR sequences for cleavage. Other approaches to the development of promising antiretroviral therapy are also being considered.

Keywords: antibodies, human immunodeficiency virus, genes, immune system, immunopathogenesis, interferon, nucleic acids, proteins.

For reference: Moskalev AV, Gumilevsky BY, Zhestkov AV, et al. Immunopathogenesis, oncogenesis, and prospects for therapy and vaccine prevention of HIV infection. The Bulletin of Contemporary Clinical Medicine. 2024; 17 (4): 149- 157. DOI: 10.20969/VSKM.2024.17(4).149-157.

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