Metabolic adverse effects of antipsychotics: the state of the problem and management options

Antipsychotic  drugs are widely used for many psychiatric disorders, such as schizophrenia, bipolar affective disorder, delusions and hallucinations  due to neurological  disorders, depression with severe psychotic  symptoms. Metabolic disorders including  weight gain, dyslipidemia and hyperglycemia  are one of the most common side effects of antipsychotic therapy. Psychiatric patients have higher risk of cardiovascular disease, so that the development of metabolic side effects is an important clinical problem that should be solved. Antipsychotic-induced weight gain may cause distress that leads to antipsychotics withdraw and repeated hospitalizations.Lifestyle changes, correction of the antipsychotic treatment, additional medications and their combination are the possible solutions of antipsychotic metabolic side effects. Lifestyle modification is a first-line therapy that should complement other options, when it feasible. At the same time, it can be extremely difficult for patients receiving antipsychotic to adhere dietary and physical activity recommendations. Replacing an antipsychotic with a milder drug is not always possible and may not be enough effective. Metformin seems to be the most well-studied, safe and effective agent that is prescribed to deal with antipsychotic-induced weight gain and associated metabolic disorders. Glucagon-like peptide type 1 receptor agonists and thiazolidinediones  are mentioned as alternative medications, but clinical data on their efficacy and safety in this patient group are extremely limited. Dyslipidemia can develop as an independent antipsychotic side effect even without an increase in body weight. The most effective treatment, as in the general population, is statin therapy. However, the joint appointment of statins and antipsychotic significantly  increases the risk of adverse reactions, such as myalgia, myopathy, increased creatine kinase levels, due to the competition of drugs for the cytochrome system.It is still unknown what scales should be used for cardiovascular risk stratification in patients taking antipsychotic and whether it is possible to use metformin to prevent antipsychotic-induced weight gain, and if so, how to select patients for whom such therapy can be indicated. Finally, more clinical trials are needed to evaluate the efficacy and safety of other classes of hypoglycemic and lipid-lowering drugs in patients on antipsychotics

Clinical Practice Guidelines of the Russian Scientific Liver Society, Russian Gastroenterological Association, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians and National Society for Preventive Cardiology on Diagnosis and Treatment of Non-Alcoholic Liver Disease

Aim: present clinical guidelines, aimed at general practitioners, gastroenterologists, cardiologists, endocrinologists, comprise up-to-date methods of diagnosis and treatment of non-alcoholic fatty liver disease.Key points. Nonalcoholic fatty liver disease, the most wide-spread chronic liver disease, is characterized by accumulation of fat by more than 5 % of hepatocytes and presented by two histological forms: steatosis and nonalcoholic steatohepatitis. Clinical guidelines provide current views on pathogenesis of nonalcoholic fatty liver disease as a multisystem disease, methods of invasive and noninvasive diagnosis of steatosis and liver fibrosis, principles of nondrug treatment and pharmacotherapy of nonalcoholic fatty liver disease and associated conditions. Complications of nonalcoholic fatty liver disease include aggravation of cardiometabolic risks, development of hepatocellular cancer, progression of liver fibrosis to cirrhotic stage.Conclusion. Progression of liver disease can be avoided, cardiometabolic risks can be reduced and patients' prognosis — improved by the timely recognition of diagnosis of nonalcoholic fatty liver disease and associated comorbidities and competent multidisciplinary management of these patients

Популяционный иммунитет к SARS-COV-2 населения Калиниградской области в эпидемический сезон COVID-19

Introduction. The COVID-19 pandemic was announced by WHO in February 2020. In the Kaliningrad region, the first case (imported) was registered in early March 2020, the beginning of the epidemic increase fell on the 14th week. 2020, and the peak incidence was reached in the 22nd week of the year, after which there was a steady decrease in the number of cases. The study of population immunity was carried out at the 32nd week during the period of the lowest level of intensity of the epidemic process.Purpose of the study. Assessment of the assessment of the level of population immunity to the SARS-CoV-2 virus among the population of the Kaliningrad region during the period of the epidemic incidence of the population of COVID-19.Materials and methods. The study was carried out as part of the first stage of the Rospotrebnadzor program to assess population immunity to SARS-CoV-2 among the population of the Russian Federation. The selection of volunteers for the study was carried out by a questionnaire survey and subsequent randomization. The analysis includes the results of a survey of 2675 people. The number of volunteers in age groups ranged from 314 to 493 people. The results obtained were processed by the methods of variation statistics.Results. The results obtained showed that the average seroprevalence in the population was 50.2%, while the highest seroprevalence was found in the child age group 1-17 years (66.9%) and among persons aged 18-29 (57.0). No significant gender differences were found (men – 48,3 ± 1,6%, women – 51,1 ± 1,1%). The distribution of the proportion of seropositive people in the settlements of the region varied from 33,9% to 59.6%. The largest share of seroprevalence in the representative samples was found among people engaged in art / creativity (55,3%), the smallest – among educational workers (42,0%). Among COVID-19 convalescents, the level of humoral immunity reached 94,6%. Most of the seropositive volunteers (95,2%) did not have any symptoms of COVID-19, that is, they belonged to the category of asymptomatic carriers.Output. The results of a survey of a representative cohort of volunteers in the Kaliningrad region showed that they are characterized by a high level of population immunity, which makes it possible to expect a decrease in.Введение. Пандемия COVID-19 была объявлена Всемирная организация здравоохранения в феврале 2020 г. В Калининградской области первый случай (завозной) зарегистрировали в начале марта 2020 г., начало эпидемического нарастания пришлось на 14-ю неделю 2020 г., а пик заболеваемости был достигнут на 22-й неделе года, после чего отмечалось устойчивое снижение количества заболевший. Исследование популяционного иммунитета было проведено на 32-й неделе в период самого низкого уровня напряженности эпидемического процесса.Цель. Оценка уровня популяционного иммунитета к вирусу SARS-CoV-2 среди населения Калининградской области в период эпидемической заболеваемости населения COVID-19.Материалы и методы. Исследование проведено в рамках первого этапа программы Роспотребнадзора по оценке популяционного иммунитета к SARS-CoV-2 среди населения Российской Федерации. Отбор волонтеров для исследования проводили методом анкетирования и последующей рандомизации. В анализ включены результаты обследования 2675 человек. Количество волонтеров в возрастных группах варьировало от 314 до 493 человек. Полученные результаты обрабатывали методами вариационной статистики.Результаты. Полученные результаты показали, что средняя серопревалентность по популяции составила 50,2%, при этом набольшая серопревалентность была выявлена в детской возрастной группе 1–17 лет (66,9%) и среди лиц в возрасте 18–29 лет (57,0). Достоверных половых различий не установлено (мужчины – 48,3±1,6%, женщины – 51,1±1,1%). Распределение доли серопозитивных по населенным пунктам области варьировало от 33,9% до 59,6%. Наибольшая доля серопревалентных в репрезентативных выборках выявлена среди лиц, занятых искусством/творчеством (55,3%), наименьшая – среди работников образования (42,0%). Среди реконвалесцентов COVID-19 уровень гуморального иммунитета достиг 94,6%. Большая часть серопозитивных волонтеров (95,2%) не имела каких-либо симптомов COVID-19, то есть относилась к категории бессимптомных носителей.Выводы. Результаты обследования репрезентативной когорты волонтеров Калининградской области показали, что для них характерен высокий уровень популяционного иммунитета, позволяющий ожидать снижения напряженности эпидемического процесса.

Разработка верифицированной шкалы риска остеоартрита на основе кросс-секционного исследования клинико-анамнестических параметров и фармакологического анамнеза пациентов

Objective: the development and verification of a scale for identifying patients at high risk of osteoarthritis (OA).Material and methods. The results of the analysis of a sample of patients aged 35–90 years from the database of the Institute of Trace Elements (n=3440), which included information on clinical and anamnestic, diagnostic parameters and pharmacotherapy of patients, including patients with OA (n=107), are presented. To analyze information about patients, modern methods of data analysis proposed within the topological theory of pattern recognition were used.Results. Based on the analysis of the sample, a 100-point scale of 27 points was developed which allows to identify patients at high risk of OA (sensitivity 88%, specificity 100%). For patients with high scores on the scale, a kind of “preemptive” prescription of symptomatic slowacting drugs for osteoarthritis (SySADOA) based on highly purified substances of chondroitin sulfate (CS) and glucosamine sulfate (GS) is promising. The evidence for CS/GS is extensive and has been reviewed previously.Conclusion. Early adoption of preventive measures (including the usage of SySADOA – CS/GS) in patients with a high score on the developed scale may reduce the risk of OA.Цель: разработка и верификация шкалы для выявления пациентов с высоким риском остеоартрита (ОА).Материал и методы. Представлены результаты анализа выборки пациентов в возрасте 35–90 лет из базы данных Института микроэлементов (n=3440), включившей информацию о клинико-анамнестических, диагностических параметрах и фармакотерапии больных, в т.ч. пациентов с ОА (n=107). Для анализа информации о пациентах использовали современные методы анализа данных, развиваемые в рамках топологической теории распознавания.Результаты. На основании анализа выборки разработана 100-балльная шкала из 27 пунктов, позволяющая выявлять больных с высоким риском ОА (чувствительность 88%, специфичность 100%). Для пациентов с высокими баллами по шкале перспективно своего рода «упреждающее» назначение симптоматических лекарственных средств замедленного действия (СЛСЗД) на основе высокоочищенных субстанций хондроитина сульфата (ХС) и глюкозамина сульфата (ГС). Доказательная база по ХС/ГС весьма обширна и была рассмотрена ранее.Заключение. Заблаговременное принятие профилактических мер (в т.ч. назначение СЛСЗД на основе ХС/ГС) у пациентов с высоким баллом по разработанной шкале может снизить риск ОА

Osteoporosis and antithrombotic therapy

Anticoagulant and antiplatelet agents are used to prevent stroke and thromboembolic events. There is insufficient data on the effect of these drugs on bone tissue. In addition, the available data are ambiguous, which increases suspicion when used in individuals at high risk of osteoporosis. The article provides data on the effect of anticoagulant and antiplatelet agents on bone metabolism, bone mineral density and the fracture risk. Literature data indicate a negative effect of heparin on bone tissue, which is increase the risk of fractures. Low molecular weight heparins has lower effect on bone tissue than heparin. It is known that vitamin K antagonists significantly affect bone metabolism and markers of bone formation, however, data on the effect on bone mineral density and the risk of fractures are contradictory. Direct oral anticoagulants are relatively safe in relation to bone tissue. Data on the effects of antiplatelet drugs on bone are ambiguous

THE ROLE OF VITAMIN D IN THE PATHOGENESIS OF CHRONIC NON-COMMUNICABLE DISEASES

This review shows the role of vitamin D in the regulation of not only the level of calcium, but also in the pathogenesis of chronic systemic inflammation, disruption of insulin sensitivity of tissues. The sufficient levels of vitamin D in the blood can lead to reduced risk of developing type 2 diabetes, obesity, autoimmune destruction of pancreatic β-cells, certain cardiometa-bolic risk factors, and therefore cardiovascular disease. Perhaps preparations of vitamin D in the near future may become additional and necessary nutritional substances for correction of insulin resistance, cardiovascular disease, chronic inflammation and prevention of disorders of glucose metabolism

HEART AND AGE (PART II): CLINICAL MANIFESTATIONS OF AGEING

Ageing is an inevitable process which affects quality of life and reduces life expectancy. Age-related cardiac changes reduce compensatory reserves of the heart and accelerate the disease development. Such changes in cardiac structure and function, observed in the absence of cardiovascular disease (CVD), are considered age-related. However, taking into account the high prevalence of CVD in the elderly, it is problematic to define the genuine cardiac ageing. This review discusses a range of subclinical cardiac conditions which are common in older people

HEART AND AGE (PART I): AGEING THEORIES AND MORPHOLOGICAL CHANGES

Heart ageing is a complex process including multiple cellular and molecular-level changes and resulting in different ageing phenotypes within the same biological species. According to the existing ageing theories, the multiple interacting mechanisms of ageing include somatic mutations, telomere shortening, oxidative stress, and mitochondrial defects. The review presents the most accepted ageing theories and discusses morphological characteristics of heart ageing on subcellular, cellular, and organ levels

HEART AND AGE (PART III): MODIFYING AGEING PROCESSES

The share of elderly people in the general population has been steadily increasing. Age is one of the main risk factors (RFs) of cardiovascular disease. However, the current focus of preventive medicine is on modifiable RFs, such as arterial hypertension, hypercholesterolemia, and smoking, while age is regarded as a nonmodifiable, non-correctable RF. This emphasises the importance of the identification of cardiac ageing mechanisms and potential modifying interventions. All the existing methods which target cardiac ageing processes have not been used in the clinical settings and require further research. The key intervention methods are described in the paper

Non-pharmacological Approaches to Treatment of Patients over 60 Years as a Way to Improve Pharmacotherapy Safety and Prevent Polypharmacy

Abstract. The demographic aging of the population of the earth observed in recent years is associated, inter alia, with the advent of new effective and safe medicines. However, the availability of highly effective drugs on the market also has a reverse side — the appearance of adverse drug reactions (ADRs), in particular as a result of drug-drug interactions. The use of non-pharmacological methods of treatment and prevention of diseases seems particularly relevant for patients of the older age group, as it allows not only to reduce the drug burden, to reduce the risk of ADRs but also to improve the patient’s state in case of diseases that have no effective pharmacotherapy and pharmacological prophylaxis. The aim of the study was to systematize and analyze data on non-pharmacological treatment methods in order to increase the safety of pharmacotherapy and prevent polypragmasia in elderly patients by informing health care providers about non-drug methods of correcting significant geriatric problems. The approaches to the correction of some major geriatric problems (delirium, sarcopenia, pain syndrome), including cognitive training, physical activity, diet, frequent reorientation of patients, placement of patients in specially equipped rooms («delirium room») were presented. The use of non-pharmacological approaches can significantly improve the safety of drug therapy, reduce the risks of ADRs, improve the patient’s prognosis and quality of life, and also effectively prevent polypharmacy