Vol 97, No 12 (2025): Vario (various)

Idiopathic recurrent pericarditis (IRP) is an orphan inflammatory disease of the pericardium, characterised by the absence of pathognomonic symptoms and specific biomarkers. The diagnosis is complicated by the absence of characteristic clinical signs and the lack of specific markers for the recurrence of IRP, which hampers the timely initiation of pathogenetic therapy and significantly worsens the prognosis. To address the challenges of complex differential diagnosis, low physician awareness, and the lack of unified guidelines for IRP for general practitioners, internists, and cardiologists, it was necessary to establish a specialized expert center. This center aims to provide synergy among highly qualified doctors from various specialisations for precise diagnosis confirmation.

Background. In rheumatoid arthritis (RA) the treatment target of remission or low disease activity is achieved in only 50–60% of patients, even with the use of modern targeted therapies, such as biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi). The failure of a bDMARD or JAKi necessitates switching to another treatment of these classes. However, the factors influencing the treatment effectiveness after such a switch remain unknown.

Aim. To identify factors associated with poor response when switching bDMARDs/JAKi in RA patients whose previous bDMARDs/JAKi were also ineffective.

Materials and methods. A total of 164 patients with RA, 46.5±14 years old, 86.6% female, RF '+' 76.8%, with Disease Activity Score – DAS28>3.2, who had failed prior bDMARD/JAKi therapy requiring a switch were enrolled. DAS28-CRP was assessed 6 months after induction of new bDMARDs/JAKi therapy. Patients with moderate/high RA activity (DAS28-CRP>3.2) were classified as non-responders (group 1), patients in remission/ low disease activity were classified as responders (group 2). Factors associated with poor response to therapy when switching bDMARDs/JAKi were identified, and then a predictive model was formed by binary logistic regression.

Results. Group 1 included 80 (48.8%) patients and group 2 included 84 (51.2%) patients. Group 1 showed statistically significantly higher body mass index (BMI), later age of onset of RA, less advanced radiological stage, baseline greater TJC (tender joint count) and SJC (swollen joint count), more severe PtPGA and PhPGA, higher DAS28-CRP, CDAI and SDAI, higher PainDetect, HADS depression, FSS, CSI, FiRST, FACIT-F, higher BPI pain (for all parameters p<0.05). A regression model for bDMARD/JAKi switching ineffectiveness with a sensitivity of 77.5% and specificity of 70.2% included BMI, RF seronegativity, CSI, PainDetect numeric score (signs of neuropathic pain), BPI (mean pain) and GC intake at baseline.

Conclusion. Initial higher RA activity, pain severity, BMI, signs of central sensitisation and psychoemotional disturbance, and need for GC are associated with a poor response to therapy when switching bDMARDs/JAKi.

Background. Recent classification of steatotic liver disorders was published in 2023, where a new form – cryptogenic steatotic liver disease (CSLD) was introduced.

Aim. To assess the prevalence of CSLD within the spectrum of liver disorders associated with steatosis, and to describe its clinical and instrumental characteristics.

Materials and methods. A retrospective search was performed in the database of subjects underwent vibration-controlled transient liver elastography (n=4,673). Criteria of CSLD and other steatotic liver diseases were based on EASL guidelines. Liver stiffness and data of controlled attenuation parameter assessment were used to establish stage of liver fibrosis and degree of steatosis of the liver. Body composition was evaluated using bioimpedance analysis. Serum parameters of lipid and carbohydrate metabolism were assessed.

Results. CSLD was found in 22 (0.8%) of total number of subjects with the presence of hepatic steatosis (n=2,643). Advanced stages of fibrosis (F2–F4) and degree of steatosis (S3) were less prevalent in CSLD group compared to MASLD: 9.1% vs 29.3%; p=0.02; S3 27.3% vs 67.6%; p<0.001 accordingly. Compared to the control group (n=266) without steatosis and fibrosis, patients with CSLD had a greater body mass index (Median [Q1–Q3]: 24.1 [22.1–24.5] kg/m² vs 22.4 [20.7–23.7] kg/m²; p=0.008), primarily due to greater fat mass (19.0 [16.6–26.7] kg vs 16.4 [12.2–20.5] kg; p=0.03). No significant difference was found between the CSLD and the control group on the demographic characteristics, serum lipid and carbohydrate metabolism parameters.

Conclusion. CSLD is a rare condition. Patients with CSLD had greater fat mass compared to the control group; however, both groups were characterized by normal values of body mass index, serum lipid and carbohydrate metaboliс parameters.

Aim. To evaluate the effect of the initiation time of lipid-lowering therapy (LLT) with the use of the proprotein convertase subtilisin/kexin type 9 (iPCSK9) inhibitor alirocumab on the incidence of adverse outcomes during 18-month follow-up after acute coronary syndrome (ACS).

Materials and methods. Two groups of patients were observed. In both groups iPCSK9 alirocumab was prescribed within a year after ACS as part of multicomponent LLT: Group 1 (n=20) – alirocumab therapy was started 3 or more months after ACS, Group 2 (n=18) – alirocumab was started up to 3 months after ACS. Control visits were performed at 3, 6, 12 and 18 months after ACS to assess the character of LLT, long-term outcomes and dynamics of low-density lipoprotein cholesterol.

Results. In groups 1 and 2, the proportions of those who achieved the target low-density lipoprotein cholesterol after 6 and 12 months, respectively, were 40.0 and 83.3% (p=0.008), 55.0 and 88.9% (p=0.024). A more than three-fold decrease in the need for rehospitalizations for any and cardiovascular reasons was noted among patients with an earlier start of PCSK9-targeted therapy. The need for cardiovascular hospitalizations directly correlated with the period (number of months) before alirocumab was prescribed (R=0.44; p=0.006).

Conclusion. The use of alirocumab as a part of outpatient low-density lipoprotein cholesterol LLT provides a powerful corrective effect on the lipid profile, as well as an improvement in long-term outcomes after ACS. The positive results of this therapy are especially noticeable when it is started within 3 months after the cardiovascular event.

The article presents a clinical case of secondary erythromelalgia in a comorbid patient with antiphospholipid syndrome, accompanied by burning pain, hyperemia and swelling of the lower extremities. A comprehensive examination involving a neurologist, dermatologist, and rheumatologist was conducted to establish the diagnosis and select the optimal therapy. Significant clinical improvement in the patient's condition is demonstrated against the background of pregabalin therapy. The importance of a multidisciplinary approach and the difficulty of diagnosis due to the lack of specific examination methods and insufficient awareness of doctors about this disease are emphasized. The described case demonstrates the need for a personalized approach to managing patients with erythromelalgia to improve their quality of life.

Background. Acute myocardial injury (AMI) is a universal pathological process that complicates both cardiac and non-cardiac pathologies. However, understanding of the molecular mechanisms underlying the various types of AMI remains insufficient. One of the current concepts for the development of AMI is the regulation of the ubiquitin-proteasome system (UPS), which mediates apoptosis and the adaptive response to injury. However, the patterns of its activation in the myocardium in various clinical situations remain poorly understood.

Aim. To evaluate and compare the expression of ubiquitin and the deubiquitinating enzymes USP28/USP40 in patients who have suffered acute myocardial injury of various etiologies.

Materials and methods. As part of a single-center prospective cohort study (RNF-NSFC "Assessment of the Role of Deubiquitinating Enzymes in Myocardial Ischemia-Reperfusion Injury and Development of Cardioprotective Agents", 2024–2026), three clinical cases were analyzed at the Clinic of the Federal State Budgetary Educational Institution of Higher Education Bashkir State Medical University of the Ministry of Health of the Russian Federation (Ufa) during the period 2024–2025. The analysis assessed and compared the dynamics of UPS activity depending on the mechanism of myocardial injury.

Results. Different causes of acute myocardial infarction demonstrate differential involvement of UPS components in the pathogenesis of coronary and non-coronary myocardial injury. IHC staining of ubiquitin in clinical cases demonstrates overexpression in the perifocal necrotic zone compared to areas more distant from necrosis, and moderate cytoplasmic and nuclear expression in myocardium without acute ischemic injury.

Conclusion. The prospects for further study of ubiquitin and deubiquitinating enzymes (USP28, USP40) in the search for potential targets for differential diagnosis and targeted therapy of AMI of various etiologies have been determined.

Probiotics are currently widely used in clinical practice to prevent and treat a wide range of diseases. The purpose of our review is to highlight what we consider to be the most significant clinical studies on the use of probiotics for preventing antibiotic-associated diarrhea, clostridial diarrhea and pseudomembranous colitis. The article also presents the results of studies confirming the efficacy of probiotics in Helicobacter pylori eradication therapy. The review focuses on Linex^® Forte, medicinal product containing the combination of Lactobacillus acidophilus (LA-5) and Bifidobacterium animalis subsp. lactis (BB-12).

In the 19th century, blood transfusions were performed according to broad indications, which makes it difficult to unify and standardize the nomenclature of previously used terms and concepts to determine the composition of patient groups. We collected and described 833 cases of intravenous blood injection for therapeutic purposes and compared the previously stated results with a modern hypothetical model of a likely favorable match of donor-recipient pairs according to the main immunological characteristics of blood, as well as studied the criteria underlying medical conclusions on the effectiveness of the procedure.