Russian Medicine

BACKGROUND: Hypertension is a major medical and social issue that requires effective preventive measures. Physician-led health education plays a critical role in enhancing patient adherence to nonpharmacological methods of prevention and treatment. However, the effectiveness and comprehensiveness of the recommendations provided remain insufficiently studied.

AIM: To evaluate patient education provided by physicians to working-age individuals under outpatient follow-up for hypertension.

METHODS: A survey of 350 patients aged 30–50 years under outpatient follow-up for hypertension was conducted, along with an analysis of their medical records using statistical methods.

RESULTS: It was found that in 84% of cases, physicians documented preventive recommendations (such as reducing salt intake and keeping a self-monitoring diary) in the medical records. These recommendations often failed to take individual patient characteristics into account. A significant association was found between the comprehensiveness of the recommendations and patient adherence: patients who received more detailed and personalized advice showed higher levels of adherence.

CONCLUSION: Physician-led patient education for individuals with hypertension should be enhanced by tailoring recommendations to individual needs, incorporating telemedicine consultations, referring patients to outpatient health schools, developing educational resources, and implementing digital monitoring tools. The findings of this study may contribute to enhancing preventive care programs within the framework of outpatient follow-up for patients with hypertension.

BACKGROUND: Wolff–Parkinson–White syndrome is one of the most well-known heart rhythm disorders characterized by pre-excitation of the ventricles. This phenomenon occurs because the electrical impulse passes through an additional conduction pathway between the atria and the ventricles. The syndrome is most commonly associated with the likelihood of supraventricular tachycardia. Numerous studies indicate the presence of a genetic component in the pathogenesis of the Wolff–Parkinson–White syndrome, which confirms its complex nature.

AIM: The study aimed to investigate the association of the rs1061657 single nucleotide polymorphism of the TBX3 gene with the Wolff–Parkinson–White syndrome.

METHODS: Patients diagnosed with the Wolff–Parkinson–White syndrome, manifesting in various clinical forms, including the Wolff–Parkinson–White phenomenon, were recruited over five years for a study based at the Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University. A total of 200 patients with the Wolff–Parkinson–White syndrome, encompassing those with the Wolff–Parkinson–White phenomenon, were examined for this paper. This group included 97 males (48.5%) and 103 females (51.5%) with a mean age of 31.9 ± 15.8 years and 38.8 ± 20.0 years, respectively. All patients underwent standard clinical, laboratory, and instrumental examinations (electrocardiography, Holter monitoring, echocardiography), as well as molecular genetic testing.

All patients were divided into the following groups by the clinical variants of the disease: 90 patients (45%) with the manifest Wolff–Parkinson–White syndrome; 60 patients (30%) with the intermittent Wolff–Parkinson–White syndrome; 46 patients (23%) with the latent Wolff–Parkinson–White syndrome; and 4 patients (2%) with the Wolff–Parkinson–White phenomenon. Excel, Statistica for Windows 10.0 (StatSoft, USA), and SPSS 20 (IBM, USA) were used for the statistical data processing.

RESULTS: A statistically significant predominance of the homozygous GG genotype was observed in the distribution of genotypes of the rs1061657 polymorphism of the TBX3 gene in patients with the Wolff–Parkinson–White syndrome compared with the control group (12.5% vs 5.5%, respectively). Furthermore, a statistically significant predominance of the G allele carriers was observed in patients with the Wolff–Parkinson–White syndrome (31.75%) compared with the control group (24.5%). The estimated risk based on odds ratio for the Wolff–Parkinson–White syndrome in the GG genotype of the TBX3 gene was 1.323-fold higher (95% confidence interval: 0.866–2.023; p = 0.04) compared with the GA and AA genotypes. In the G allele carriers, the odds ratio for the Wolff–Parkinson–White syndrome was 1.434-fold higher (95% confidence interval: 1.051–4.127; p = 0.028) compared with the A allele.

CONCLUSION: The study results confirmed that the rs1061657 polymorphism of the TBX3 gene contributes to the development of the Wolff–Parkinson–White syndrome.

BACKGROUND: Apoptosis is a genetically programmed form of cell death. It is essential for maintaining homeostasis in the body. A key feature of apoptosis is the maintenance of normal cell population, with caspases playing a central role and potentially contributing to the pathogenesis of specific long COVID phenotypes. Identifying the role of caspases and their association with clinical markers may provide additional evidence for the causes of this syndrome.

AIM: To determine the role of caspase-6 in patients with dyspnea or its equivalents in long COVID.

METHODS: A single-center, cross-sectional observational study was conducted over a 3-year period, when 878 patients sought medical care for dyspnea or its equivalents at an outpatient clinic, with 186 patients included in the study.

RESULTS: All patients in the study had caspase-6 levels within the reference range. Caspase-6 concentration in the long COVID group (group 1, n = 86) was significantly lower than that in the control group (group 2, n = 100) with no history of COVID-19. To identify risk factors for decreased apoptotic activity and increased pro-inflammatory responses, 86 patients with long COVID and dyspnea were stratified into two subgroups based on caspase-6 levels: 33 patients (38.4%) with caspase-6 > 26.5 pg/ml and 53 patients (61.6%) with caspase-6 ≤ 26.5 pg/ml. Severe COVID-19 pneumonia was associated with a nearly 7-fold increase in the relative risk (RR) of reduced apoptotic activity and an increase in pro-inflammatory responses in the post-COVID period: RR 6.85; 95% confidence interval (CI) 1.02–143.74. It also increased the risk of elevated N-terminal pro-B-type natriuretic peptide level > 120 pg/ml by more than 2-fold (RR 2.41; 95% CI 1.27–5.14), carotid-femoral pulse wave velocity > 10.6 m/s by 4-fold (RR 4.10; 95% CI 1.45–11.77), aortic pulse wave velocity > 8.3 m/s by 3-fold (RR 3.22; 95% CI 1.31–9.62), increased ferritin level > 152.5 ng/ml. It reduced transferrin saturation < 19.8% by 2.5-fold (RR 2.49; 95% CI 1.23–5.75), and increased tissue inhibitor of metalloproteinases-1 level > 376.1 ng/ml by 69% (RR 1.69; 95% CI 1.10–2.72).

CONCLUSION: Long COVID-related dyspnea is associated with reduced caspase-6 levels, which correlate with impaired apoptotic activity and heightened inflammatory responses. Proposed pathophysiological mechanisms underlying caspase-6 deficiency include activation of myocardial stress pathways, increased collagen deposition, hyperferritinemia, and arterial stiffness.

BACKGROUND: In surgical dentistry and maxillofacial surgery, no currently available bone graft material reliably provides predictable outcomes for the treatment of jawbone defects. Given the increasing number of patients with alveolar bone atrophy and post-traumatic jaw defects, the development of new materials with osteoinductive properties remains highly relevant, underscoring the importance of research in bone tissue engineering.

AIM: To assess the osteoinductive potential of a novel bone graft material based on poly(3-hydroxybutyrate) loaded with simvastatin in an in vivo sheep model.

METHODS: A single-center, prospective, comparative study was conducted between December 2022 and June 2023, involving 24 healthy sheep weighing 65–70 kg and aged 18–24 months. Strict inclusion and exclusion criteria ensured group homogeneity. Under general and local anesthesia, a lateral window approach to the maxillary sinus was performed to create a bony window for implantation. Group 1 received simvastatin-loaded poly(3-hydroxybutyrate) granules; group 2 received the same material without simvastatin. The primary outcome was the presence of morphological signs of osteoinduction, including the formation of new bone tissue. Secondary outcomes included morphometric assessment of structural bone parameters, such as the relative volume of newly formed bone and osteogenic activity.

RESULTS: Assessments were performed at 3 and 6 months post-implantation. At 3 months, granules of the bone graft material in group 1 were surrounded by moderate connective tissue and multiple foci of active osteogenesis around the simvastatin-loaded granules. In group 2, connective tissue predominated around the implanted granules, with isolated osteogenic foci. At 6 months, group 1 exhibited reduced connective tissue, persistent osteogenic foci, and predominantly mature lamellar bone. Histomorphometric analysis revealed that the relative volume of newly formed bone in the simvastatin group was 34.5% at 3 months and 63.4% at 6 months, significantly exceeding that of the control group (21.4 and 36.8%, respectively).

CONCLUSION: Simvastatin-loaded poly(3-hydroxybutyrate) granules significantly enhance bone formation. However, the long-term effects of simvastatin application require further investigation.

Medicine of the 21^st century has an extensive arsenal of means for diagnosing diseases. High-tech equipment can detect pathologies without clinical manifestations during the latent stage of disease development. Actigraphy is a portable device based on an accelerometer, used for tracking sleep parameters, and also, well established as a tool for monitoring the circadian rhythms of a person. Actigraphy is not an alternative to the use of polysomnography, however, it has advantages in ease of use, cost, and size of the device, in addition to allowing long-term continuous recording of night and daytime sleep over several days or weeks in the patient's home sleep environment. In addition to its primary function — the study of sleep characteristics — actigraphy is widely used as a method for detecting and monitoring diseases, including cognitive impairment, psychiatric disorders, cardiovascular pathologies, and respiratory diseases.

In this review, we have compiled current information on actigraphy as a tool for disease diagnosis. The described results allow us to summarize the useful characteristics of such a diagnostic tool and shed light on applying this progressive and reliable method in medicine.

This review compares the clinical and morphological characteristics of synovial sarcoma in children and adults (over 18 years of age). Russian medical publications do not provide statistical data on the incidence of synovial sarcoma in different age groups in Russia. However, according to available data, synovial sarcoma accounts for 4% of malignant soft tissue tumors in children and adolescents; the highest incidence is reported in patients aged 15–35 years, with males slightly outnumbering females. In children, synovial sarcoma is the most prevalent type of sarcoma other than rhabdomyosarcoma, accounting for approximately 30% of all sarcomas detected in childhood. Thus, this condition is one of the most significant challenges in pediatric oncology. Synovial sarcoma in children frequently affects the limbs, particularly the areas near joints, making early diagnosis difficult because symptoms can overlap with those of injuries or inflammation. Notably, synovial sarcomas in children and adults have several distinct clinical and pathomorphological characteristics. Tumors in children are frequently more aggressive, which is associated with high cell proliferation and an increased risk of early metastasis. In adults, the disease may develop more slowly, but it is more likely to be detected at later stages due to less severe symptoms. Clinical manifestations of synovial sarcoma include pain, swelling, and limited mobility in the affected area. However, these symptoms may be less severe in children, making timely diagnosis difficult. Pathomorphological characteristics of the tumor include a biphasic structure with both epithelioid and spindle cell components, necessitating a thorough histopathological examination to make an accurate diagnosis. Synovial sarcoma is a significant medical concern in both pediatric and adult oncology. Further research is warranted to clarify epidemiological data and develop effective approaches to early diagnosis and personalized treatment.