Vol 26, No 1 (2025): Опубликован 28.03.2025

Levosimendan is increasingly being used to treat heart failure and cardiac dysfunction in pediatric patients. Currently, there is limited evidence that this drug has a positive effect on treatment outcomes. The aim of the literature review was to investigate the effects of levosimendan on hemodynamic parameters and outcomes in pediatric patients in various clinical settings. The study design was a systematic review of randomized and non-randomized studies.

Randomized clinical trials were included in the meta-analysis. The primary outcome of the meta-analysis was the effect of levosimendan on central venous oxygen saturation (ScvO₂) and lactate levels as surrogate markers of low cardiac output syndrome. Study participants were pediatric patients (age <18 years) receiving levosimendan compared with any control. Forty-two studies published between 2004 and 2021 were identified, including a total of 1131 pediatric patients. Nine studies (including 547 patients) were RCTs, all conducted in the pediatric cardiac surgery setting. In the RCTs, the use of levosimendan was associated with a significant improvement in ScvO₂ (p = 0.03) and a trend toward lower postoperative lactate levels (p = 0.08). No differences in secondary outcomes were found.

The use of levosimendan in pediatric patients is not associated with serious side effects and may lead to hemodynamic improvement after cardiac surgery. However, its effect on major clinical outcomes remains to be determined. Overall, the quality of evidence for the use of levosimendan in pediatric patients is low, and further high-quality studies are needed.

Background: The acute phase of the new coronavirus infection, COVID-19, is accompanied not only by damage to the respiratory system but also to the cardiovascular system and exacerbation of chronic diseases. This has led to a significant imbalance in the ability to provide various diagnostic tests, especially for patients with coronary heart disease (CHD).

Aim: The availability of methods for non-contrast assessment coronary artery calcium (CAC) and coronary computed tomographic (CT) angiography (coronary CTA) for outpatients with suspected or established CHD, in comparison with the “waves” of the rise in the incidence of COVID-19 during the pandemic.

Methods: A retrospective search was conducted for anonymized heart computed tomographic angiography protocols for 2019-2022 performed in the Voronezh Regional Clinical Advisory and Diagnostic Center. The analysis of COVID-19 incidence in the Voronezh region was based on data from the regional medical information system, as well as official WHO data on daily COVID-19 cases in Russia. To assess the impact of time series on each other, the Granger causality test was used.

Results: An increase in the number of heart CT scans performed during the autumn-winter period was revealed, while a decrease in their number during spring and summer was also noted. The distribution of CT scan numbers during the working day had a bimodal nature, with peaks at 08:00 - 09:00 and at 14:00 – 15: 00. The large “waves” of COVID-19 in Russian Federation and Voronezh Region had no effect on the prediction of coronary CTA numbers. Analysis of 394 scans showed that stenosis ≥50% in the trunk of left coronary artery occurred in 3.2% of cases, stenosis of the proximal right coronary artery was 11.4%, stenosis of anterior descending artery was 22%, and stenosis of circumflex artery was 10.9%.

Conclusion: Coronary CTA is an affordable method for assessing the condition of coronary arteries, which can easily be integrated into the algorithm for examining outpatients with suspected or established CHD, including those in need of revascularization. Analysis of the work of radiology department during the pandemic revealed a minimal influence of "waves" in the increase in COVID-19 incidence on the coronary CTA numbers.

The article presents a clinical case of a patient with multiple endocrine pathology that develops over a long period of time and in the absence of necessary medical supervision. The patient has a complex lesion of the thyroid gland, parathyroid glands and adrenal glands. The presence of a nodular goiter, the hormonal activity of which was not dynamically controlled, was complicated by the manifestation of thyrotoxicosis and the development of severe cardiological pathology. Subsequently, prolonged independent medication thyrostatic therapy led to the development of clinical hypothyroidism. In addition, the patient was diagnosed with parathyroid adenoma with the development of primary hyperparathyroidism and the adrenal gland cancer incident.

Background: Employees of special units of the Ministry of Internal Affairs and the National Guard of Russia are exposed to intense physical loads, which require high endurance and cardiovascular adaptation. However, such adaptation may mimic pathological conditions, such as cardiomyopathies, complicating differential diagnosis. This study aimed to investigate echocardiographic changes and cardiac adaptation in these individuals compared to a control group.

Methods: The study included 37 male employees of special units (mean age 38 ± 6 years) with regular physical activity of at least 15 hours per week and 33 age- and BMI-matched controls (mean age 37 ± 7 years) without regular exercise. All participants underwent electrocardiography (ECG) and transthoracic echocardiography (TTE). Left ventricular (LV) dimensions were measured using the Teichholz method, and systolic function was assessed using the modified Simpson’s biplane method. Statistical analysis was performed using Statistica v. 6.0.

Results: In the main group, 48% had sinus bradycardia (heart rate <60 bpm), and 8% had incomplete right bundle branch block. Echocardiography revealed significantly larger LV end-diastolic dimensions (57.5 [48; 61] mm vs. 51 [47; 56] mm, p < 0.05) and right ventricular (RV) basal dimensions (45.5 [37; 49] mm vs. 37.5 [33; 42] mm, p < 0.05) compared to controls. LV ejection fraction was within normal limits in both groups (59.5 [54; 62]% vs. 60.4 [53; 61]%). Signs of RV and left atrial dilation were observed in 56.7% and 13% of the main group, respectively. No significant valvular pathologies were detected.

Conclusion: Employees of special units exhibit echocardiographic changes consistent with volume load adaptation, including chamber dilation and increased LV mass index.

Diabulimia is a new complication of type 1 diabetes mellitus, which affects one third of patients aged 15 to 30 years. However, "diabulimia" is not yet an official diagnosis. This problem is considered as a repetitive, abnormal, compensatory behavior associated with the refusal of insulin in order to control body weight. Standard methods of diagnosis and treatment of eating disorders have shown their ineffectiveness in "diabulimia". This article describes possible predisposing factors, mechanisms of development, as well as methods of diagnosis, treatment and prevention.

Relevance. Recently, the incidence of obesity among the child population has been steadily increasing. Adipokine hormones, which affect the level of metabolic processes, play a significant role in the development of this pathology. One of these substances is spexin, which is currently being considered as a possible marker of cardiometabolic risk in obese patients.

Goal. To study the level of specsin in obese children using a glucagon-like peptide-1 receptor agonist liraglutide.

Materials and methods. A study of the level of spexin was conducted in obese children before the start of therapy and 3 months after the use of liraglutide. The level of spexin was determined by enzyme immunoassay using a set of Spexin/Neuropeptide Q reagents.

The results obtained and their discussion. The study included 23 patients with an established diagnosis of constitutionally exogenous obesity of II-III degrees and morbid obesity, and a group of patients with 20 children over 12 years of age with a normal BMI was taken for comparison.As a result of our study, it was revealed that the level of spexin in obese children was higher than in healthy children, but at the same time it was within the reference values. According to the results of our studies, when repeated treatment 3 months after the start of liraglutide therapy, there are significant differences in the level of spexin not identified.However, significant changes in body weight were noted in the study group (before the start of therapy, the average value was 98 kg, after 3 months this indicator was 90 kg).

Conclusion. No data were found on the effect on the level of spexin in children during complex therapy using a glucagon-like peptide-1 receptor agonist liraglutide. At the same time, a positive effect of therapy was observed, which manifested itself in a decrease in body weight in the study group of patients.

Hypoxic brain damage can lead to the formation of long-term neurological disorders in the form of delayed psychomotor skills, delayed speech and intellectual development. Due to anatomical and physiological features, the central nervous system of late premature infants (newborns born at 34 0/7 - 36 6/7 weeks of gestation) is more susceptible to the influence of unfavorable factors than children born at term. Analysis of anamnestic data allowed us to identify factors that increase the risk of neurological disorders in late preterm infants (LPI). Such factors include: arterial hypertension in the mother, chronic fetoplacental insufficiency, menstrual cycle disorders, frozen pregnancy in the woman's anamnesis, threat of pregnancy termination, delayed intrauterine development of the fetus, oligohydramnios, maternal age 32 years and older. The combination of such pathologic conditions leads to the formation of long-term oxygen deficiency in the fetus and damage to its central nervous system (CNS).

Introduction. Modern society over the last decades has been facing the problem of de-clining birth rate, directly related to the deterioration of reproductive health of young people. In this regard, adolescence should be considered a significant period of formation of values of a healthy lifestyle, knowledge directly affecting reproductive health in the future and the prin-ciples of the family institution lost at the present stage [3,4].

Objective.To study the level of adolescents' awareness of reproductive health and the need for reproductive health education.

Materials and Methods. Our study is an anonymous questionnaire survey of 150 schoolchildren in Voronezh at the age of 12 to 17 years (79 boys and 71 girls), the sample is random.

Results. Analysis of the obtained data revealed insufficient awareness of schoolchildren about reproductive health. Despite the presence of basic knowledge about health, a significant number of adolescents cannot give clear answers to questions about basic concepts and com-ponents of female and male health. An alarming fact among girls is the lack of information and lack of motivation for new knowledge about menses, and among boys - a low level of aware-ness of the consequences of bad habits.

Conclusions. Adolescent schoolchildren do not have a sufficient level of knowledge about reproductive health, which necessitates educational activities to inform and raise aware-ness in this area, which will affect their health and well-being in the future.

The introduction of photometric analyzers based on the "dry chemistry" method has significantly improved the quality and information content of general urinalysis. For the correct interpretation of the results, it is necessary to take into account both the diagnostic capabilities and limitations of this method. Discrepancies in the results obtained by microscopy of urine sediment often mislead doctors of clinical departments. A deeper understanding of the principle of operation of the "dry chemistry" method will make it possible to more accurately interpret the data of a general urinalysis, identify the influence of interfering factors and pathological changes.

Introduction. This study focuses on the diagnostic role of markers of cellular stress and endothelial dysfunction in patients with type 2 diabetes mellitus and obesity. Cellular stress and endothelial dysfunction are key pathophysiological mechanisms that contribute to the progression of these diseases. We analyzed the general block (gender, age), anthropometric block (height, weight, BMI, waist circumference, fat mass, fat percentage, free fat mass, total, amount of water), anamnestic block (the fact of coronary heart disease onset, the time of coronary heart disease onset, the duration of diabetes mellitus, the fact of smoking), lipid profile data were taken into account (total cholesterol, HDL, LDL, TG), analyzed the level of various biomarkers associated with cellular stress (HSP70, HSP27) and the state of the endothelium (endothelin, stable metabolites of NO, ADMA, hs-CRP) in a group of patients with diabetes and obesity, with diabetes, in the control group. The findings of the study emphasize the importance of assessing markers of cellular stress and endothelial dysfunction as potential diagnostic tools for early diagnosis and monitoring of the condition of patients with type 2 diabetes mellitus and obesity. These findings may facilitate the development of more targeted strategies for the treatment and prevention of cardiovascular disease in this patient group.