Evaluation of the impact of unhealthy nutrition on the intestinal microbiota, mitochondrial function and the formation of multiple organ metabolic syndrome, ways of correction

BACKGROUND: The problem of metabolic syndrome is considered a demographic catastrophe. According to WHO experts,«by 2025, the prevalence of metabolic syndrome (MS) in the world will amount to more than 300 million people, and in the next 25 years it is expected to increase by 50%.» The pathophysiological mechanisms of MS formation and the role of unhealthy diet on the development of intestinal dysbiosis, mitochondrial insufficiency remain unclear.AIM: To study the effect of unhealthy diet on the state of the intestinal microbiota and the development of metabolicmitochondrial insufficiency in the formation of a multi-organ metabolic syndrome, evaluation of ways of correction.MATERIALS AND METHODS: Clinical picture assessment, anthropometric data (body mass index), laboratory results (glucose, cholesterol and fractions) were carried out in patients with MS, triglycerides, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, lipid peroxidation indicators: malondialdehyde, diene conjugates, schiff bases, hydroperoxides, catalase, superoxide dismutase, succinate dehydrogenase (ASDH), α-glycerophosphate dehydrogenase (α-AGFDH). Hemorheological parameters were evaluated by the apparent viscosity of blood, the yield strength, the aggregation coefficient of erythrocytes and platelets. The microbiota and microbiome of the intestine were evaluated by species, strain composition and the level of metabolites-propionic, butyric, acetic acid, lipopolysaccharides, peptidoglycans. A questionnaire was conducted to study the nature of nutrition.RESULTS: The study included 128 patients with MS and 25 healthy individuals. According to medical outpatient records from anamnesis, questioning of each patient, complaints and clinical picture, 26.2% of patients had type 2 diabetes, 3.74% of men had erectile dysfunction, 7.5% of women had polycystic ovaries, 15.1% had night apnea syndrome, 8.7% hyperuricemic syndrome, 96.5% of patients had metabolic fatty liver steatosis. According to the results of the survey, it was revealed that 99.8% of patients adhered to an unhealthy and unbalanced, high-calorie diet, 46.4% of patients had a low level of physical activity, 48.7% had an average. The revealed disorders of lipid, carbohydrate metabolism, microbiota and intestinal microbiome were associated with increased lipid peroxidation, decreased levels of antioxidant defense enzymes, indicators reflecting mitochondrial function against the background of hemorheological disorders.CONCLUSION: In multi-organ MS, unhealthy diet can be considered as a targeted risk factor triggering pathophysiological mechanisms at the level of the intestinal microbiota, followed by a cascade of metabolic disorders in the form of activation of lipid peroxidation with inhibition of antioxidant defense enzymes, the development of multi-organ mitochondrial insufficiency and the development of latent hemorheological syndrome. The revealed metabolic complex obviously constitutes a multiorgan morphological cluster underlying the development of multi-organ metabolic syndrome. Based on the identified disorders, pathogenetically justified correction of MS should include a balanced diet with mitochondrial protective therapy

An Integrated Approach to the Management of a Multimorbid Patient with Atrial Fibrillation from the Standpoint of Modern Guidelines: Rivaroxaban is in Focus

Atrial fibrillation (AF) is a complex pathology that requires an integrated approach in both diagnosis and treatment, including optimal prevention of thrombosis, control of clinical symptoms, and identification and treatment of cardiovascular risk factors and comorbidities. The article analyzes some of the new positions of the recommendations of the European Society of Cardiology on atrial fibrillation, presented in 2020. Effective diagnostic and therapeutic approaches are discussed in the management of patients with AF in conditions of multimorbidity. The basic principles of the CC to ABC concept, introduced with the aim of improving a structured approach to the treatment of patients with AF, and the 4S-AF regimen necessary for decision on the use of oral anticoagulants, choosing a method of control of the rhythm and / or its frequency, choosing between ablation, cardioversion and antiarrhythmic drugs, as well as to determine the mode of treatment of major cardiovascular diseases. To improve the prognosis and achieve the best results in these patients, the most important is to reduce the risk of stroke, control cardiovascular risks and comorbidities, and ensure high adherence to the therapy within the framework of the concept of comprehensive patient protection. Rivaroxaban is considered by the authors of the article as one of the drugs that provides comprehensive anticoagulant protection of patients with AF. The efficacy profile of rivaroxaban in the prevention of acute cerebrovascular accident and high safety rates were confirmed in a population of multimorbid AF patients of different ages and the highest risk of stroke and / or bleeding

FROM THE HISTORY OF ACUTE MESENTERIC OCCLUSION (THE EPOCH OF NEW TIME). Part I

Acute mesenteric occlusions and acute bowel infarction were described in the middle of the nineteenth century. In spite of the achievements of modern medicine acute mesenteric ischemia is still one of the most dangerous pathologies in emergency surgery. This survey covers the historical periods of research of certain aspects of acute infarction of mesenteric circulation, which shaped our modern perception of this disease

COMPLEX APPROACHES TO TREATMENT OF DYSLIPIDEMIA IN PATIENTS WITH ISHEMIC HEART DISEASE

The risk of coronary heart disease increases significantly with an increase in blood cholesterol and low density lipoprotein (LDL). We know that is not always standard therapy fails to achieve target numbers of blood lipids in patients with coronary artery disease. We examined 100 patients with coronary heart disease (CHD): stable angina II-III functional — study group (60 patients) and control group (40 patients). The studies we have obtained evidence that the combination of plasmapheresis, ultraviolet blood irradiation and statins to reduce total cholesterol in patients IIFK 2,7% IIIFK 23,3%, LDL cholesterol in patients IIFK 30,4%, IIIFK 37,3% (r<0,05). Following the combination therapy achieved level of hyperlipidemia can be maintained with lower doses of statins

POSSIBILITIES OF ANXIETY-DEPRESSIVE DISORDERS TREATMENT IN PATIENTS WITH CHRONIC HEART FAILURE

Aim. To study the efficacy and safety of D-, L-gopantenic acid/Pantogam active in the complex treatment of congestive heart failure and coronary heart disease in patients with symptoms of anxiety-depressive disorder. Patients and methods. 82 patients with NYHA II-III heart failure, anxiety and depression were enrolled in the study.Material and methods. The severity of psychological disorders and the efficacy of 8-week therapy with Pantogam active were assessed using Hamilton Depression Rating Scale (HDRS), Hospital Anxiety and Depression Scale (HADS), State Trait Anxiety Index (STAI), and Clinical Global Impression (CGI) Scale. The quality of life was evaluated using the Short Form 36 (SF-36) Health Survey. Global improvement or change of psychological symptoms by CGI Scale were considered as efficacy criteria. Standard diagnostic tools, i.e., echocardiography and 24-hour Holter monitoring, were applied as well.Results. 8-week treatment with Pantogam active of patients with heart failure and depression greatly reduces the severity of anxiety-depressive disorders, improves physical activity tolerance and vegetative regulation of heart rhythm, and decreases heart rate in supraventricular and ventricular arrhythmias.Conclusions. In heart failure patients, anxiety-depressive disorders are accompanied by significant disturbances of heart rhythm vegetative regulation, development of supraventricular and ventricular arrhythmias, physical activity intolerance, increased hospital admission rate, and decreased quality of life. 8-week treatment with Pantogam active due to its bimodal action significantly improves these symptoms and the quality of life

EFFECTIVE TREATMENT OF PATIENTS WITH CHRONIC HEART FAILURE AND DEPRESSIVE DISORDERS WITH NOOTROPICS DRUG PANTOGAM ACTIV

We investigate the efficiency of the inclusion nootropic drug Pantogam Activ in the complex therapy of 82 patients with heart failure, ischemic heart diseases, anxiety and depressive disorders. It was shown that an 8-week treatment with Pantogam Activ in most patients is accompanied by a significant reduction of anxiety and depressive disorders, increase exercise tolerance, improved autonomic regulation of heart function and decrease the frequency of supraventricular and ventricular arrhythmias, which is accompanied by a marked improvement in the quality of life