Consilium Medicum

Background. Cognitive impairment (CI) is one of the most common geriatric syndromes, which has a significant negative impact on the autonomy and quality of life of older patients. It seems promising to study the association of the neuropsychological status of individuals over 90 years old with the parameters of their clinical and geriatric status in order to identify potential modifiable risk factors for the occurrence and progression of CI in this age group.

Aim. To assess the relationship between hormonal and metabolic parameters and the neuropsychological status of long-livers.

Materials and methods. The study included 3494 people aged 90 years and older. During a medical team visit, the study participants underwent a comprehensive geriatric assessment, as well as blood sampling to determine a number of metabolic and hormonal parameters. Cognitive functions were assessed using the Mini Mental State Examination, as well as the Frontal Assessment Battery. Depression symptoms were assessed using the Geriatric Depression Scale. Statistical analysis of the data was performed using the R programming languages version 4.2.2. and Python version 3.9.12.

Results. Despite the correlation between the test results on the scales described above, different types of dementia have their own hormonal and metabolic markers. Thus, it is neurodegenerative conditions diagnosed with Mini Mental State Examination, that are associated with HDL-cholesterol and apolipoprotein A1. Whereas frontal dysfunction diagnosed with Frontal Assessment Battery is more associated with adiponectin. For depression, no unique markers not associated with the progression of CI were found.

Conclusion. Different hormonal and metabolic parameters make a significant contribution to determining the severity of cognitive impairment in long-livers, depending on the specific type of neurological disorders. The obtained data require confirmation in prospective studies and may further be promising for optimizing guidelines for diagnosis, treatment and prevention of CI in long-livers.

The article provides an overview of the literature data on cardiovascular diseases in cancer survivors over the long term. Particular attention is paid to the adverse effects of radiation therapy. Clinical guidelines for cardiac risk stratification and monitoring of long-term cardiovascular complications of antitumor treatment are provided. A clinical case of a radiation-associated heart disease is presented.

In this article, we present an overview of studies conducted in recent years to determine the prognostic value of various diagnostic methods at the stage of preoperative examination and risk prediction in various planned extracardiac interventions, based on current clinical guidelines and the capabilities of modern medicine. The relevance of the presented topic is undoubted, given that more than 200 million different non-cardiac surgeries are performed worldwide annually, the share of cardiac complications exceeds 50% of patients, and a consensus on the scope of examination and the prognostic parameters obtained is not always possible to achieve. A clear algorithm for preoperative examination, identification and consideration of prognostically significant parameters affects the stratification of perioperative risk, the choice of anesthetic and surgical tactics, the strategy of postoperative patient management, which is the basis for reducing the risk of cardiovascular complications.

Background. Analysis of risk factors for tuberculosis allows us to assess targeted areas in the fight against tuberculosis.

Aim. To analyze risk factors for the spread of tuberculosis in Russia and the North Caucasus Federal District.

Materials and methods. The study of risk factors was carried out according to literature data for 2016–2023 and epidemic statistics of tuberculosis for 2018–2022 for Russia and the North Caucasus Federal District.

Results. Epidemic indicators of tuberculosis at the present stage are influenced by both endogenous and exogenous factors. Tuberculosis is still a socially significant disease. Social risk factors for tuberculosis include: inaccessible location and remoteness of the place of residence, difficult working and living conditions, marginal behavior, including poor sanitary and financial standards, the presence in a person’s biography of periods of detention in penitentiary institutions, the presence of homeless people, the presence of migrant workers. Medical risk factors for tuberculosis include: alcoholism, drug addiction, nicotine addiction, chronic nonspecific lung diseases, gastric ulcers and gastritis, diabetes mellitus, and oncological pathologies. Some of the above risk factors lead to the emergence of undertreated patients and increase the risk of developing tuberculosis in children who are in close contact with disadvantaged adults. The largest proportion of tuberculosis patients is noted to be of working age 35–44 years. The epidemic intensity of tuberculosis remains due to the presence of hidden and uncontrollable sources of infection in population groups for which anti-tuberculosis measures are difficult or impossible. HIV infection remains the main endogenous risk factor for tuberculosis.

Conclusion. HIV infection and the spread of multidrug-resistant tuberculosis lead to the development of infectious foci with new characteristics. The incidence of multidrug-resistant tuberculosis is increasing in Russia and the North Caucasus Federal District; a sharp jump occurred in 2022 compared to 2021. The proportion of patients with a combination of tuberculosis and HIV infection among all patients with tuberculosis is constantly growing.

Background. Ménière's disease is a multifactorial disease characterized by recurrent dizziness, fluctuating hearing changes, congestion and noise in the ear. Despite the fact that spontaneous remission was registered in 71% of patients 8 years after the onset of the disease, a number of patients have a progressive course of the disease, in 10% of cases with bilateral lesions, debilitating episodes of dizziness, and hearing loss. Visualization of endolymphatic hydrops (EH) is performed using gadolinium-enhanced inner ear magnetic resonance imaging (MRI), by intravenous or intratympanic administration. Surgical treatment is recommended in case of ineffectiveness of drug therapy for 6–12 months; drainage of the endolymphatic sac (DEM) has been considered as an option in world practice since 1927.

Aim. To evaluate the change in EH after drainage of the DEM using intratympanic gadolinium-enhanced MRI of the inner ear.

Materials and methods. The study included 26 patients with Ménière's disease: 18 women and 8 men aged 20 to 71 years, with an average disease duration of 8.15 years (±7.04). The average duration and frequency of seizures before surgery were 4.29 hours (±3.29) and 6.08 times (±5.81) per month, respectively. All patients underwent DEM drainage, and the follow-up period was 1 year. An Intratympanic gadolinium-enhanced MRI of the inner ear was performed before and 6 months after surgery and evaluated in accordance with the criteria of Barani (2015).

Results. After EM drainage, a positive result of vertigo control was achieved in 17 (65.39%) patients. MRI examination at the preoperative stage revealed: pronounced vestibular hydrops, moderate cochlear EH – 14 (53.84%) patients, pronounced vestibular EH, pronounced cochlear EH – 8 (30.77%) patients, pronounced cochlear EH – 2 (7.69%) patients, moderate vestibular EH – 1 (3.85%) patient, severe vestibular EH – 1 (3.85%) patient. Six months after the operation, a control MRI examination with intratympanic gadolinium showed the following: without EH – 3 (11.54%) patients, decrease EH – 16 (61.54%) patients, no dynamics – 7 (26.92%) patients. The study showed a decrease in the degree of EH after DEM in 61.54% of cases according to intratympanic gadolinium-enhanced MRI of the inner ear.

Conclusion. Gadolinium-enhanced MRI data on endolymphatic hydrops changes in Ménière's disease patients, obtained before and after endolymphatic sac drainage, clearly demonstrate the effectiveness of this surgical treatment approach.