Russian Medicine

BACKGROUND: The multimorbidity of affective, cognitive, and cardiovascular diseases is an urgent issue of the contemporary medicine due to their severity, resistance to therapy, social maladjustment, and low quality of life. Common pathogenetic mechanisms, including endothelial dysfunction and disorders of the frontal and subcortical connections, enhance these conditions, increasing the risks of dementia and mortality.

AIM: To study the clinical and psychopathological structure of affective disorders and comorbid cognitive disorders in inpatients with cardiovascular diseases in various age groups.

METHODS: An observational, single-center study was conducted from January 2023 to June 2024 at the University Clinic of the Russian University of Medicine. The study involved 121 patients with cardiovascular diseases and non-psychotic mental disorders, including 47 (38.8%) with comorbid affective and cognitive disorders. The patients were divided into three age groups, 45–59, 60–74, and 75–90 years. Clinical psychopathological and psychometric (Hospital Anxiety and Depression Scale, Montreal Cognitive Assessment) and neuropsychological methods (clock drawing test, Luria’s method) were used. Statistical analysis was performed using Fisher’s exact test and Student’s t-test.

RESULTS: In 85.1% of patients, we detected organic emotional disorders, mainly with alarming symptoms. Significant differences in the clinical structure of affective disorders between the groups indicate age-related differences (p = 0.045). Cognitive disorders (visual and constructional praxis, attention, memory, abstract thinking) are associated with vascular changes and dysfunction of the frontal lobes. The Montreal Cognitive Assessment scores were in the range of 18–27; the average score in the 45–59 group (24.9 ± 0.3) was higher compared to the 60–74 (23.5 ± 0.2; p < 0.05) and 75–90 groups (23.4 ± 0.3; p < 0.05). Moderate cognitive disorders were detected in 55.3% of cases, severe cognitive disorders were detected in 19.2% of cases, and 25.5% of cases were within the normal range. Subjective cognitive complaints related to the risk of dementia were not confirmed by tests in 27.6% of cases. Attention and abstract thinking disorders increased with age (p < 0.05); whereas speech disorders showed no significant differences (p > 0.05).

CONCLUSION: The study highlights the importance of early diagnosis and an interdisciplinary approach to multimorbid conditions and a qualitative analysis of the psychopathological and pathopsychological structure of affective and cognitive disorders in cardiovascular cases. The limitation is the small sample size, requiring further research on a larger sample of patients.

BACKGROUND: Heart rate variability indicators in ice hockey athletes have been explored very poorly thus far. Investigating correlations between the indicators of heart rate variability and on-ice testing (the most efficient method for assessing special work capacity, energy supply, and adaptation of ice hockey players) is highly crucial given the labor intensity, high cost, and invasiveness of on-ice testing.

AIM: To study heart rate variability indicators in ice hockey defensemen during on-ice tests and to identify correlations between the metrics resulting from the examination using two methods.

METHODS: The study involved ten defensemen from a major league hockey team aged between 19 and 34 during the season of play. The study methods included: pulse measurement using the PolarTeamPro2 team system; determination of lactic acid content in blood using a photometric method; estimation of special work capacity, energy supply, and blood buffer capacity of players through on-ice testing; 5-minute rhythmocardiography using the KFS-01.001 Cardiometer-MT electrocardiograph (MIKARD-LANA, Russia). Results data were statistically processed using the Excel-2017 software.

RESULTS: Seven out of ten athletes (70%) had type 3 heart rate regulation according to Shlyk’s classification. Based on the median spectral indicators, it turned out that the central heart rate regulation circuit (low-frequency waves and very low-frequency waves) was dominant in defensemen. The total wave spectrum growth significantly correlated with the heart rate recovery indicators in the sample of defensemen (the correlation coefficient was −0.69) and suggested that the characteristics of the defensemen were close to the model characteristics of on-ice testing (correlation coefficient of 0.689). The value of the parasympathetic component of the wave spectrum (high-frequency waves) significantly negatively correlated with the test completion time (correlation coefficient of −0.48) (special work capacity) and blood lactate in on-ice testing (correlation coefficient of 0.515).

CONCLUSION: Improvements in the cardiovascular system’s adaptation to special ice work and the approximation of defensemen’s characteristics to model characteristics are closely related to an increase in overall heart rate variability and the central heart rate regulation circuit. The dynamics of heart rate variability indicators can be used as an operational control over ice hockey defensemen.

BACKGROUND: Gut microbiota and vitamin D may be instrumental in the development of atopic responses (atopic dermatitis, allergic rhinitis, allergic asthma, and food allergies) in children. Various diseases or immune pathologies, in particular atopic dermatitis and food allergies, are among manifestations of an imbalance in the composition of gut microorganisms. On top of that, vitamin D is a significant contributor both to modulating the gut microbiome composition and to diverse immune responses from innate and adaptive immunity, which affords ground for studying the relationship between these aspects in the context of the development of atopic conditions. So far, the relationship between the gut microbiota, vitamin D, and the development of these conditions in children has not been sufficiently explored.

AIM: To study the relationship between the gut microbiota imbalance and immune disorders, in particular the development of food allergies and atopic dermatitis in children; to identify the relationship between bacterial signatures and vitamin D concentrations in children with atopic dermatitis and food allergies.

METHODS: The 16S ribosomal ribonucleic acid gene of 150 fecal samples from children aged 3 to 12 years was sequenced. The concentration of vitamin D in the participants’ blood serum was determined using enzyme-linked immunosorbent assay. Thereafter, the relationship between certain bacterial signatures and serum 25(OH)D concentration was characterized through the use of statistical models (regression tree, correlation analysis, and linear regression).

RESULTS: In all mathematical models used, vitamin D concentration turned out to be associated with bacterial families important for atopy, such as Lachnospiraceae, Ruminococcaceae, and Sutterellaceae. The results showed that dysbiosis coupled with vitamin D deficiency is typical of the atopic profile, which may indicate the influence of these conditions on the immune system imbalance toward the Th2 response and, consequently, on the development of allergic conditions.

CONCLUSION: Certain bacterial patterns specific to atopy are associated with vitamin D concentration in blood serum. In consequence of the study, we concluded that the gut microbiota and vitamin D may be systematically involved in modulating immune responses. Further research is needed to attain full comprehension of the mechanisms underlying these associations and to determine the most efficient interventions for the prevention and treatment of autoimmune conditions.

BACKGROUND: Relative energy deficiency in sport (RED-S) and low energy availability are major issues in modern sports. The constant prevalence of energy expenditure on training and competition over energy intake is the main risk factor for these conditions to occur. Quantifying energy deficiency in everyday practice is rendered difficult, but questionnaires can be an effective tool for timely screening of low energy availability and RED-S.

AIM: To conduct a systematic review of questionnaires used to assess RED-S risk factors in athletes.

METHODS: The presented review was conducted in concert with the methodological guidelines found in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. A search was conducted through the PubMed, Google Scholar, Embase, Scopus, CINAHL, Medline Ovid, and SPORTDiscus electronic databases from January 2010 to February 2025. The review covered articles setting forth issues regarding the assessment of reproductive health and manifestations of RED-S.

RESULTS: Out of the 29 studies included in the review, ten unique questionnaires were found to identify athletes at risk of energy deficiency. Nine questionnaires were validated, three of which included only screening for eating disorders, without assessing other symptoms or training activity. Two questionnaires were most frequently used in studies and practice: the low energy availability in females questionnaire and the eating disorder examination questionnaire.

CONCLUSION: Questionnaires can be effective in identifying intentional energy restriction, early detection of gynecological pathology, and the risk of energy deficiency in female athletes. Questionnaires are screening tools but not methods for diagnosing RED-S.

The gut microbiota is a complex of microorganisms, mainly bacteria, inhabiting the human intestines. Microorganisms of the intestinal microflora influence metabolism, immunological reactivity, and pathogenesis of various diseases, such as diabetes mellitus, obesity, inflammatory bowel diseases, and others.

This article examines the influence of intestinal microflora on the development of type 2 diabetes mellitus and its treatment options.

A review of publications shows that microbiota imbalance may be associated with various metabolic disorders, which is confirmed by many studies. Active metabolites affecting the development of type 2 diabetes mellitus include short-chain fatty acids, imidazole propionate, trimethylamine N-oxide, branched-chain amino acids, and tryptophan metabolites. These compounds can affect the metabolic processes in the body, including insulin sensitivity, inflammatory reactions, and glucose metabolism, which may eventually contribute to the development of type 2 diabetes mellitus.

Studying the interaction of the gut microbiota with drugs is challenging as the underlying biological mechanisms are not fully understood.

The key discussed aspects also include the contemporary treatment landscape of type 2 diabetes mellitus associated with the microbiome, namely the use of metformin as a sugar-lowering drug; the use of pro- and prebiotics; dietary and lifestyle interventions; fecal microbiota transplantation, and smoking cessation. All these treatment options show ability in controlling microbiota to manage the disease and improve therapy outcomes. Further research in this area opens up opportunities for the development of innovative treatment strategies for type 2 diabetes mellitus focused on the health of the intestinal microflora. Understanding the impact of microbiota on metabolic disorders will help to develop personalized treatment approaches and lead to improved health in patients with type 2 diabetes mellitus.