<h3>АКТУАЛЬНОСТЬ</h3> Дорсопатии шейного отдела позвоночника относятся к наиболее распространенным болезням опорно-двигательного аппарата. Боль в шее нередко ассоциируют с дегенеративно-дистрофическим поражением позвоночника, но это не всегда так. Использование методов нейровизуализации и статистической обработки данных в оценке патогенетических факторов формирования грыжевых выпячиваний межпозвонковых дисков (МПД) является наиболее рациональным. В нашем исследовании инициирована попытка описания биомеханических процессов в структуре дорсопатий шейного отдела позвоночника. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучение изолированного влияния биомеханических факторов на процесс формирования смещений дискового материала (выпячивания) за пределы пространства МПД шейного отдела позвоночника. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Объектом исследования явилась случайная выборка, состоящая из 124 исследований с применением магнитно-резонансной томографии (МРТ) шейного отдела позвоночника различных пациентов. Все исследования были разделены на 9 групп в соответствии с типами шеи: короткая толстая, короткая промежуточная, короткая тонкая, средняя толстая, средняя промежуточная, средняя тонкая, длинная толстая, длинная промежуточная, длинная тонкая (1—9-я соответственно). <h3>РЕЗУЛЬТАТЫ</h3> Биомеханические факторы оказывают изолированное влияние на формирование грыжевых выпячиваний шейного отдела позвоночника. Главным критерием оценки эффективности рычага позвоночно-двигательного сегмента является значение <i>tg α</i>, которое определяется как отношение <sup>1</sup>/<sub>2</sub> высоты диска на уровне переднего края позвонков в сагиттальной плоскости и отрезка, соединяющего середину расстояния между межпозвонковыми суставами, и передний край МПД. Полученные данные свидетельствуют, что эффективность рычага позвоночно-двигательного сегмента C<sub>V</sub>—C<sub>VI</sub> и C<sub>VI</sub>—C<sub>VII</sub> оказывает наибольшее влияние на процесс формирования выпячиваний МПД в молодом возрасте. <h3>ЗАКЛЮЧЕНИЕ</h3> Исследование продемонстрировало достоверное влияние биомеханического фактора на формирование грыжевых выпячиваний МПД в шейном отделе позвоночника у молодых людей; при этом очевидно, что у лиц старшего возраста механический фактор оказывает наименьшее воздействие, что, вероятно, обусловлено возрастными и дегенеративными изменениями МПД. Предложенный способ оценки влияния механического фактора на формирование грыжевых выпячиваний МПД позволяет прогнозировать развитие дорсопатий шейного отдела у лиц молодого возраста, а также при дальнейшем изучении может быть использован при моделировании послеоперационных осложнений оперативного лечения на шейном отделе с применением имплантов. Внедрение в повседневную практику МРТ способа оценки влияния рычага 2 рода на процесс формирования смещения дискового материала позволит увеличить информативность исследования и персонализировать лечебный процесс, разработать индивидуальный комплекс превентивных медицинских мероприятий. 

Anatomical assessment of the biomechanical factors isolated influence on the process of disc material displacements beyond the of intervertebral space within the cervical spine segment in the structure of dorsopathies

Fixed combination of orphenadrine and diclofenac in the treatment of acute spondylogenic pain syndromes

Background. Many COVID-19 survivors suffer from post-COVID syndrome, which significantly worsens the quality of life. Its presentation is quite diverse, with cognitive disorders being of particular importance. Liver injury due to the direct virus action and the treatment of the new coronavirus infection can persist for a long time during the recovery period and lead to hyperammonemia, which can cause cognitive disorders, including minimal hepatic encephalopathy. 
Aim. To study cognitive disorders in post-COVID syndrome and the possibility of their treatment with L-ornithine-L-aspartate. 
Materials and methods. The study included 30 students from 18 to 24 years old who had COVID-19 and decreased attention, memory impairment, and other cognitive disorders inherent in hepatic encephalopathy of latent (grade 0) or mild (grade 1) severity, without pronounced impairment of intelligence, memory, speech, and learning ability. Hyperammonemia, elevated alanine aminotransferase, aspartate aminotransferase, and -glutamyl transpeptidase, signs of hepatic encephalopathy according to psychometric tests, were reported in young people. All patients in the study were treated with L-ornithine-L-aspartate to correct the ammonia blood level and improve signs of hepatic encephalopathy and the general condition. 
Results and conclusion. An improvement in the objective findings, liver enzymes, a decrease in ammonia level, and an improvement in testing results for changes in cognitive functions were reported.

Mild post-COVID syndrome in young patients

Aim. To evaluate the impact of community-acquired pneumonia (CAP) on the levels of cardiac biomarkers and long-term survival rate in patients with heart failure (HF). Material and methods. The prospective observational single-center study included 132 patients (73 men, 59 women); mean age — 72,3±12,1 years, consecutively hospitalized at Clinical Hospital № 4 of the I. M. Sechenov First Moscow State Medical University with decompensated heart failure in the period from March 2018 to December 2019. The main (n=40) and comparison group (n=92) included patients with and without clinical and CT signs of CAP, respectively. Results. Patients with HF and CAP and HF without CAP were comparable in sex, age, and severity of HF. CAP in most patients met the criteria for non-severe pneumonia (average CURB-65 score — 1,55±0,73). The levels of N-terminal probrain natriuretic peptide (NT-proBNP) in patients with HF with CAP (1188,9 [439; 2493] pg/ml) were insignificantly higher than in patients with HF without CAP (839,6 [413; 1900]) pg/ml (p&gt;0,05). A similar pattern was noted for the soluble growth stimulation expressed gene 2 (sST2) (30,85 [12,8; 59,6] ng/ml vs 22,8 [15,2; 44,7] ng/ml, p&gt;0,05). The haptoglobin level in patients with CAP was significantly lower (732 [315; 1312] ng/l), compared to the group without CAP (1270 [902; 2022] ng/l, p=0,0022). No differences in the concentrations of galectin-3, copeptin and hepcidin were detected. The one-year mortality rate of patients who underwent CAP was 27,3%, and without CAP — 7,2% (p&lt;0,001), while the three-year mortality rate was 44,9% and 21,4%, respectively (p=0,0004). Elevated levels of NT-proBNP and sST2, along with age over 75 years and left ventricular ejection fraction &lt;40%, are additional factors of poor prognosis in patients with HF and CAP. Conclusion. CAP in patients with HF does not have a significant effect on most cardiac biomarkers, but significantly worsens the prognosis. Independent factors of unfavorable prognosis in patients with HF and CAP are age over 75 years, left ventricular ejection fraction &lt;40%, increased NT-proBNP and sST2 levels. 

Levels of cardiac biomarkers and three-year survival rate in hospitalized patients with heart failure and community-acquired pneumonia

Musculoskeletal disorders are an important cause of work absence. Clinical practice guidelines recommend nonsteroidal anti-inflammatory drugs (NSAIDs) for grade I-II cervical sprains. The combination of thiamine + pyridoxine + cyanocobalamin vitamins has been used, alone and in combination with NSAIDs, for pain and inflammation in musculoskeletal disorders. 

pdf/a-randomized-control-trial-of-dexketoprofen-vitamin-b-59pnmmes0o.pdf

A Randomized Control Trial of Dexketoprofen/Vitamin B (Thiamine, Pyridoxine and Cyanocobalamin) Fixed-Dose Combination in Post-Traumatic Grade I–II Cervical Sprains

Objective: to comparatively study several nonsteroidal anti-inflammatory drugs (NSAIDs) (their analgesic effect; dynamics of quality of life; side effects, such as NSAID-gastropathy and gastric dyspepsia) in acute pain in the neck and back (dorsalgia). Patients and methods. The investigators followed up 120 patients (4 groups, each having 30 people) with acute dorsalgia who took different oral NSAIDs for 7 days: long-acting ketoprofen, aceclofenac, naproxen, and dexketoprofen (Flamadex). To evaluate their possible side effects, dyspepsia symptoms were monitored and blood pressure (BP) was measured daily; gastroscopy was repeated after completion of a treatment cycle. The Nottingham Quality of Life Questionnaire and the Visual Analogue Scale (VAS) for pain were used. Results and discussion. A gradual and substantial reduction in pain measured according to VAS was noted in all the NSAID-treated groups. The intensity of pain syndrome decreased faster in the dexketoprofen group; the analgesic effect of naproxen and long-acting aceclofenac was significantly less (p=0.012 and 0.002, respectively). This patient group showed a tendency to maximum improvement according to the Nottingham Quality of Life Questionnaire and VAS. Elevated BP was observed in all the groups, but statistically significantly more frequently in the naproxen group (p=0.05). Gastric dyspepsia was also registered in all the groups, but a tendency to its lower frequency was seen in the dexketoprofen group. Conclusion. Dexketoprofen showed fewer side effects and a more pronounced analgesic effect than ketoprofen, aceclofenac, and naproxen in acute dorsalgia.

https://nnp.ima-press.net/nnp/article/download/1303/1025

Efficacy and safety of different nonsteroidal anti-inflammatory drugs for acute neck and back pain

Aim. To assess the prognostic role of cardiac biomarkers (galectin-3, soluble ST2 (sST2), and N-terminal pro-brain natriuretic peptide (NT-proBNP)) in risk stratification of adverse cardiovascular events (CVEs) in patients with heart failure (HF) after implantation of an automatic implantable cardioverter-defibrillator (AICD) within 12-month follow-up period.Material and methods. The study included 57 patients (men, 41; mean age, 65 (59; 68) years) with coronary artery disease and NYHA class II-III HF with left ventricular ejection fraction of 34 [26; 40]%. All patients were implanted with AICD. Serum levels of NT-proBNP, sST2, and galectin-3 were determined by enzyme immunoassay prior to AICD implantation.Results. It has been established that in order to stratify the risk of unfavorable HF in patients after AICD implantation for 12-month follow-up, all three studied biomarkers can be considered as prognostic factors. Thus, an increase in the level of NT-proBNP ≥1046,6 pg/ml (AUC=0,68; p=0,009), sST2 ≥34,43 ng/ml (AUC=0,78; p<0,0001) and galectin-3 ≥11,6 ng/l (AUC=0,72; p=0,0014) predicts a high risk of adverse CVEs. The combination of sST2 and galectin-3 increased the predictive value of the analysis (AUC=0,84; p<0,0001), while the addition of NTproBNP did not increase the accuracy of risk stratification.Conclusion. The determination of the combination of galectin-3 and sST2 can potentially help identify a group of patients with HF after AICD implantation with a high risk of adverse CVEs for intensification and optimization of treatment.

Cardiology Research Institute, Tomsk National Research Medical Center

Asthenia and fatigue are the most common syndromes in patients with liver disease, which significantly affects their quality of life. The prevalence of fatigue in chronic liver diseases is from 50% to 85%. While some progress has been made in understanding the processes that can cause fatigue in general, the underlying causes of fatigue associated with liver disease remain not well understood. In particular, many data suggest that fatigue associated with liver disease likely results from changes in neurotransmission in the brain against the background of hyperammonemia. Hyperammonemia is a metabolic state characterized by an increased level of  ammonia, a  nitrogen-containing compound. The  present review describes hyperammonemia, which is likely important in the pathogenesis of fatigue associated with liver disease. Ammonia is a potent neurotoxin, its elevated blood levels can cause neurological signs and symptoms that can be acute or chronic, depending on the  underlying pathology. Hyperammonemia should be recognized early, and immediately treated to prevent the development of life-threatening complications, such as, swelling of the brain and coma. The article gives pathophysiological mechanisms of influence of hyperammonemia on state of psychovegetative status of patients with liver diseases, also lists basic principles of treatment. A significant part of the article is devoted to L-ornithine-L-aspartate, which is effective in asthenia and fatigue to reduce the level of hyperammonemia through a variety of well-studied mechanisms in chronic liver diseases.

Asthenia and fatigue in hyperammonemia: etiopathogenesis and methods of correction

Results of percutaneous coronary interventions in patients with coronary artery disease and previous coronary artery bypass grafting

Introduction. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a pandemic by the World Health Organization (WHO) in March 2020. New waves of different virus genotypes regularly roll across the globe. Recent studies show the most serious prognosis for patients with known cardiovascular disease, indicating a possible relationship between SARS-CoV-2 infection and an increase in new cases of cardiovascular diseases and diabetes regardless of the severity of the pathology. If this trend is true, with hundreds of millions of infected patients the disease burden might presage a potentially alarming rise of cardiovascular diseases and diabetes in the future.The aim is to study the laboratory test results of patients with novel coronavirus infection COVID-19 with underlying type 2 diabetes mellitus (DM) and chronic heart failure.Materials and methods. A  total of  51  patients with a  verified diagnosis of  moderately severe novel coronovirus infection COVID-19 with underlying type 2 diabetes and chronic heart failure were included in the study. All patients underwent quantitative laboratory blood tests. Correlation analysis was carried out using the Spearman’s rank correlation coefficient.Results and discussion. In our opinion, the most interesting were numerous correlations between glucose levels and internal organs and systems dysfunction markers: with bilirubin levels, international normalized ratios, creatinine levels, with carbon dioxide (ctCO2 ) levels, bases (BE) levels, with the bicarbonate (HCO3  act) levels. The most pronounced (rs  = 0.74) was the correlation between glucose levels and basophil counts, which may suggest a  possible effect of  hypersensitivity mechanisms on the severity of hyperglycemia in patients with COVID-19.Conclusions. The hyperglycemia level indicates the severity of not only metabolic acidosis, but also the internal organs and systems dysfunction in patients with novel coronavirus infection COVID-19 with underlying type 2 diabetes and heart failure. 

Features of laboratory parameters in the new coronavirus infection COVID-19 against the background of diabetes mellitus and chronic heart failure

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