The article demonstrates the practical experience of the effective use of inhibitor of sodium-glucose co-transporter 2 emplagliflozin as a part of optimal drug therapy in patients with decompensation of chronic heart failure with systolic dysfunction of ischemic genesis and type 2 diabetes mellitus. The place of this group of drugs in improving the quality of life and prognosis in patients with severe comorbidity has been indicated according to the data of evidence-based studies.

Changes in the nature of the interaction of risk factors and global aging of the population have led to a rapid increase in patients with combined pathology, elevated to the rank of a new non-infectious epidemic. The previously existing ‘one disease, one patient’ paradigm is losing its relevance and no longer meets medical needs, therefore patients with comorbidities need a broader approach and individualized treatment regimens, which are currently not fully defined. According to modern concepts, the coexistence of pathogenetically and pathophysiologically interrelated two or more diseases in one individual is defined by the term ‘comorbidity’. The most common comorbidity phenotype is cardiometabolic. Of particular interest is the relationship between cardiovascular disease (CVD) and non-alcoholic fatty liver disease (NAFLD), since both diseases are highly prevalent in the population and have common metabolic risk factors (obesity, diabetes mellitus, hypertension, and dyslipidemia). In addition, there is evidence that NAFLD is an independent risk factor for CVD, which suggests not only the presence of common pathogenetic mechanisms other than metabolic pathways, but also the likelihood that treatment of liver disease can reduce the burden of CVD. In this regard, this review comprehensively analyzes the relationship between NAFLD and CVD and discusses a possible therapeutic strategy, including the use of a combination of ademetionine with ursodeoxycholic acid.

Objective. Patients with stage 5 chronic kidney disease.

Study objective. Determination of factors affecting cognitive function in patients with CKD-5.

Design and methods. The study included young and middle-aged patients (18 to 60 years old) (n = 40), there is a terminal stage of chronic kidney disease (CKD). Exclusion criteria: history of diseases of the central nervous system, brain injury, episodes of cerebrovascular accident with severity, coronary artery disease, chronic heart failure, pregnancy, abuse of alcohol, refusal to participate in the study. In a previous work, patient examination data were obtained on the Status PF hardware complex. Neurodynamic indicators were estimated, including the determination of the time of a simple visual-motor reaction (MTCM) and a complex visual-motor reaction (MPSM), reaction to a moving object (RDO), memory and attention. Using Spearman’s correlation analysis, we evaluated the impact on cognitive functions of a number of factors, presumably related to neurodynamics. The following factors were selected: age, creatinine level, NSE and S100 proteins, hemoglobin level, Beck’s depression points, indicators of personal and situational anxiety.

Results. All patients examined on the Status PF software package had mild cognitive impairment in terms of neurodynamics, attention, and memory. The average positive relationship between the level of depression and various indicators of RDO was established: with RDO_average (ρ = 0.405; p = 0.018), with RDO_total delay (ρ = 0.540; p < 0.001), with RDO_average delay (ρ = 0.421; p = 0.007), as well as weak positive – with CEMR average exposure (ρ = 0.358; p = 0.023). An average positive relationship of creatinine level with RDO_O (ρ = 0.438; p = 0.005) is noted. A weak positive relationship between the level of personal anxiety and RDO_total delay (ρ = 0.334; p = 0.035) was revealed. The average negative relationship between hemoglobin level and RDO_total delay (ρ = –0.535; p < 0.001) was revealed. A weak positive relationship between situational anxiety and SEMR is determined by the number of errors (ρ = 0.364; p = 0.021), as well as a weak negative one with the attention volume (ρ = –0.357; p = 0.024). A weak negative relationship of age with visual memory per word was revealed (ρ = –0.362; p = 0.022).

Domain of usage. Outpatient and hospital treatment stages of patients with chronic kidney disease case management

The aim of the study. To compare different methods for assessing comorbidity in terms of its long-term predictive value after myocardial infarction (MI).

Materials and methods. The analysis included 1176 patients with MI who were consecutively admitted to the hospital. The incidence of STsegment elevation MI was 60%; every second patient underwent endovascular intervention. All patients underwent an analysis of the severity of comorbidity according to the CIRS system (Cumulative lllness Rating Scale), according to the CCI (the Charlson’s comorbidity index), the CDS scale of chronic diseases (Chronic Disease Score), as well as according to their own model ‘K9’ (patent RU2734993C1 dated 10.27.2020) based on the summation of nine diseases: type 2 diabetes mellitus, chronic kidney disease, atrial fibrillation, anemia, stroke, arterial hypertension, obesity, peripheral atherosclerosis, thrombocytopenia.

Results. Long-term mortality was 12.1 %. In Cox regression analysis of long-term survival after MI, the K9 model showed the best operational characteristics with a p < 0.00001 level. In multivariate analysis, when comorbidity data were added to GRACE, an increase in the χ2 value for GARCE + CCI and GRACE + K9 to 102.5 and 99.3, respectively, and the values of the area under the ROC curve to 0.78 (0.74–0, 82) and 0.77 (0.72–0.81), respectively. Regardless of the initial level of risk assessed by the GRACE scale, severe comorbidity (four or more diseases according to the K9) significantly increased the relative risk of mortality. In patients with severe comorbidity, the predictive value of the GRACE scale was the lowest.

Conclusions. Among the analyzed methods of assessing comorbidity, only CCI and its own K9 scale have an acceptable predictive value, allowing better adaptation of the GRACE scale for stratification of the long-term risk of death after MI. At the same time ‘K9’, based on the summation of nine previously described diseases, is much more convenient than CCI in practical application

More than 500 medicines are included in the database of the World Health Organization as drugs that can cause acute inflammation of the pancreas. Drug-induced acute pancreatitis develops against the background of taking many medications (statins, antitumor drugs, drugs for the treatment of diseases of the gastrointestinal tract, analgesics and anti-inflammatory drugs, antimicrobial, antiparasitic and antiviral drugs, drugs for the treatment of tuberculosis, diseases of the central nervous system, estrogens, calcium preparations, etc.) from different classes, while the clinical picture does not differ from pancreatitis of other etiology. Based on this, it is worth paying attention to the reasons that contributed to the development of this pathology. Therefore, one of the main principles of the diagnosis of drug-induced pancreatitis is a thorough collection of a pharmacological history. If you suspect that pancreatitis was caused by a drug, you should immediately stop using it and start traditional therapeutic treatment.

Hyponatremia (HN) is one of the leading water-electrolyte disorders in daily medical practice. A decrease in sodium level is dangerous with the development of various complications. Therefore, for effective prevention of HN and its complications, special attention should be paid to modifiable risk factors. One of the important causes leading to HN is drugs. Most often, HN develops during therapy with thiazide and thiazidelike diuretics. Risk factors for its development are history of thiazide-induced HN, advanced age, female sex, low body weight, and hypokalemia. The problem of thiazide-induced HN requires further study of the pathogenetic mechanisms and determination of the genetic factors underlying it. It is also necessary to remember about the possibility of HN development against the background of such drugs widely used in therapeutic practice as blockers of the renin-angiotensin-aldosterone system and proton pump inhibitors. In patients receiving therapy with the listed drugs, it is necessary to pay attention to the possible clinical manifestations of HN and to determine the sodium level in dynamics, which will effectively prevent the development of this disorder.

Every drug may cause central nervous system, gastrointestinal tract or cardiovascular system adverse drugs reactions (ADRs). At the same time, doctors often do not have sufficient information about possible food-drug interactions, in particular, garlic. But this spice is shown to increase the risks of developing ADRs. From the beginning of the 20th century to the present, garlic has been the subject of many chemical studies, which have revealed some differences in the chemical composition of the studied preparation (fresh or stored garlic). The most important chemical ingredients found in garlic are divided into two groups: sulfur-containing (allicin [diallyl thiosulfinate], allyl methanesulfinate, alliin [S-allyl-L-cysteine sulfoxide, diallyl disulfide, DADS], S-allylmethyl cysteine, diallyl trisulfide [diallyl trisulfide, DATS], allyl methyl trisulfide, allyl methyl disulfide, diallyl tetrasulfide, allyl methyl tetrasulfide, dimethyl trisulfide, diallyl sulfide, 2-vinyl-4-H1,3-dithiine, 3-vinyl-4.-H1,2-dithiin) and sulfur-free compounds. Most of the pharmacological effects of garlic are due to sulfur compounds, in particular allicin. In animal, in vitro and clinical studies, it has been shown that garlic can interact with various drug througt pharmacokinetic or pharmacodynamic way. For example, garlic extract has shown to inhibit the metabolic activity of CYP2C9*1, 2C19, 3A4, 3A5, 3A7, but not CYP2D6. It has also been shown that garlic can affect the function thrombocyte and blood clotting, which leads to an increased risk of bleeding, which is especially important in the case of its simultaneous use with antiplatelet agents and/or anticoagulants. This article provides an overview of the open literature on the risks and benefits of the simultaneous use of drugs and products containing garlic.