Regional Clinical Research

Background. Kidney transplant (KT) recipients are a high-risk group for atherosclerotic cardiovascular disease (CVD), closely linked to dyslipidemia. Objective. To demonstrate the efficacy and safety of a novel proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, inclisiran, for hyperlipidemia correction in and reduction of the risk of developing CVD in KT recipients. Material and methods. A series of clinical cases included five patients (two men, three women, mean age 56±10 years) with high cardiovascular risk, dyslipidemia, and persistently elevated low-density lipoprotein (LDL) levels, despite ongoing statin and ezetimibe therapy. Inclisiran targeted therapy was prescribed for secondary (4 patients) and primary (1 patient) CVD prevention. Subcutaneous inclisiran injection (284 mg in 1.5 mL solution) was administered in KT department, repeat injection was made after three months, the next injections were performed after 6 months. Dynamic studies of blood LDL, creatinine, tacrolimus levels were performed using standard methods. Results. Adjunctive inclisiran therapy led to a reduction in blood LDL levels by an average of 32% at two weeks, 40% at one month, and 55% at three months. Continued treatment maintained target LDL values. Inclisiran treatment caused no adverse effects and had no negative impact on transplanted kidney function. Conclusion. KT recipients with high risk of atherosclerotic CVD represent a promising group for lipid-lowering therapy including inclisiran.

The Padova Muscle Days, an international congress on striated skeletal and cardiac muscles, was founded in 1985. Its goal was and continues to be to translate basic research findings into clinically relevant results. Indeed, function and mass of skeletal striated muscle are influenced by and affect central and peripheral neural pathologies, as well as lifestyle, aging, and cancer. Over the years, changing names three times has led to innovative multidisciplinary results, that are now emphasized by a neologism included in the title of the congress series: "Padua Days on Muscle and Mobility Medicine (Pd3m)". Mobility Medicine is used to bring together knowledge currently dispersed across too many subspecialties. Scientific conferences, held in hotels large enough to accommodate all participants, increase opportunities for discussions during breaks and evenings, bringing together young and senior experts in basic sciences and clinical specialties. This offers young scientists many opportunities for collaborations and jobs. We are confident that this will occur during the next conference in March 3 to 6, 2026. [...]

Aim. To determine the correlation of the level of insulin-like growth factor-1 (IGF-1) with the extent of the lesion, the degree of activity of ulcerative colitis (UC), the presence of pseudopolyps and neoplasia of the colon, as well as chronic pancreatitis. Materials and methods. 25 patients with UC aged 30-40 years were examined. All patients underwent endoscopic examination of the colon, endosonographic examination of the pancreas to verify the presence of criteria for chronic pancreatitis (CP) and a blood test for enzyme immunoassay for IGF-1 levels. A correlation analysis was performed with the calculation of Spearman’s rank correlation coefficient (CC) with the determination of the closeness of the relationship between the signs on the Chaddock scale. Results. The study of the dependence of the amount of IGF-1 in the blood serum and the severity of inflammation in the colon showed a high degree of closeness, the CC was equal to -0.871. A significant correlation was also found with the presence of CP in UC (CC -0.601). The determination of the dependence of the presence of pseudopolyps and neoplasia of the colon and the level of IGF-1 did not show a statistically significant correlation between the studied signs. Conclusion. IGF-1 levels have an inverse correlation with the severity of inflammation in the colon and the presence of chronic pancreatitis in UC, which makes it possible to use the amount of this protein as a marker for verifying the degree of UC activity and the presence of CP.

The aim of the study. To evaluate the effectiveness of monitoring the preventive examination of risk groups to be screened for tuberculosis using medical information systems. Materials and methods . A retrospective study was conducted on the effectiveness of occupational examinations from 2021 to 2024 among risk groups to be screened for tuberculosis. The forms of state statistical observation No. 30 and No. 33, as well as the functional features of the Moscow Region MIS (in particular, Medinfo and Barclay) have been studied. Results. Over four years of observation, despite uneven population dynamics among risk groups, their structure remained unchanged. A trend toward an increase in the number of routine medical examinations overall and among medical risk groups, as well as the proportion of tuberculosis patients newly identified during routine medical examinations, was observed. Tuberculosis detection rates in risk groups ranged from 0.1–0.2 per 1,000 examinations for oncopathology and diabetes to 3.1 per 1,000 examinations for patients with HIV infection. The proportion of patients with destructive forms of pulmonary tuberculosis among individuals who had not been examined for two or more years reached 44%. Conclusion. Medical information systems designed for the rapid collection and analysis of data have proven themselves to be a convenient and objective tool for preventive medical examinations of the population in real time.

Introduction. Exploring the role of B-group vitamin deficiencies in patients with cardiometabolic disorders is important today. Aim. To study changes in biomarkers for cardiometabolic risk in patients with B-group vitamin deficiencies with underlying insulin resistance and carbohydrate metabolism disorders. Materials and methods. Seventy patients with abdominal obesity combined with prediabetes or type 2 diabetes were included, 35 of whom received Neuromultivit, 1 tablet twice a day, and 35 patients with abdominal obesity combined with prediabetes or type 2 diabetes who only received a backbone therapy. The observation period was 12 weeks. All patients underwent a preand post-observation examinations, including blood chemistry tests (C-reactive protein, lipid profile, glucose, HbA1C, insulin, homocysteine, B1, B6, and B12 vitamins) and neuropsychological testing such as MoCA test, Schulte Table test, and the Clinical Global Impression (CGI) -based assessment. Results. During Neuromultivit therapy, improvements were noted in the following parameters: a 0.6 [0.4; 0.9] ng/ml increase in vitamin B1 level (p < 0.001), a 4.6 [3.7; 7.7] ng/m increase in vitamin B6 level (p < 0.001), B12 level by + 256 [202; 474] pg/ml (p < 0.001); homocysteine level decreased by -2.2 [-2.5; -1.6] μmol/l (p < 0.001), glucose level by 0.17 [-0.23; -0.12] mmol/l (p < 0.001); HbA1c level by -0.04 [-0.05; -0.04] % (p = 0.002), insulin level by -0.5 [-0.8; -0.3] μIU/ml (p < 0.001), waist circumference (WC) decreased by -4 [-6; -3] cm (p < 0.001), the MoCA test result improved by +1 [1; 2] score (p < 0.001), the Schulte Table tests showed boosting in speed by -2.1 [-2.3; -1.5] sec, p < 0.001), CGI-I-based assessment demonstrated “significant improvement” in a greater number of patients (p < 0.001). In the control group, no significant positive changes were observed in any of the parameters studied. Conclusions. Neuromultivit therapy resulted in significant replenishment of B-group vitamin deficiencies, improvement of cardiometabolic parameters and cognitive functioning as compared to the control group.

This article presents an overview of current research on determining target blood levels of vitamin D. It examines the biochemical and metabolic properties of vitamin D, as well as the challenges of standardizing 25(OH)D measurements and the variability of threshold values across populations. It discusses ambiguities in scientific data and the need to consider individual factors when interpreting vitamin D levels. This review is unique in its comprehensive approach to analyzing the effects of vitamin D not only on bone health but also on immune and metabolic functions, which broadens ever evolving understanding of the clinical significance of vitamin D. This work emphasizes the importance of personalized recommendations for vitamin D dosing and prescription based on current clinical data and scientific standards. Performed analysis highlights the need for personalized vitamin D supplementation to reach and maintain blood levels between 30 and 60 ng/mL, noting that higher levels might be necessary for people with genetic or acquired resistance. These insights substantiate the development of evidence-based, personalized clinical strategies for the prevention and treatment of vitamin D deficiency-related disorders. The synthesized data offer significant implications for advancing research and clinical practice in endocrinology, obstetrics, dermatology, neurology and immunology.

IntroductionAcromegaly is often associated with menstrual dysfunction and infertility due to secondary hypogonadism and/or hyperprolactinemia in women of reproductive age. However, this does not exclude the possibility of pregnancy and the birth of a healthy child; only about 160 cases have been described in the literature. We would like to present a clinical case of successful management of pregnancy in a patient with uncontrolled acromegaly.Clinical caseFemale, at age 30 a spontaneous pregnancy occurred, the child died at 8 months due to Arnold-Chiari syndrome. At age 33 the second pregnancy ended in a natural delivery and the birth of a healthy child. Since that she noted swelling, an increase in the size of her extremities, at age 35 – hypertension up to 180/100 mm Hg, pain in the knee and ankle joints, and decreased vision. MRI revealed a pituitary macroadenoma 15х18х21 mm. The tests showed IGF-1 467 ng/ml (41-246), prolactin 25.9 ng/ml (4.79-23.3). Neurosurgery was performed, immunohistochemical analysis showed an expression of somatostatin receptors type 2, Ki-67 index 6%; 3 months after IGF-1 379 ng/ml, lanreotide therapy was initiated. Despite medical treatment, acromegaly was uncontrolled, IGF-1 level increased to 598 ng/ml. At age 38 an unplanned pregnancy was detected (gestational age 8 weeks). The last injection of lanreotide was a month ago, IGF-1 246 ng/ml, and the drug was cancelled. Visual field were monitored regularly during pregnancy - without negative dynamics. Non-contrast pituitary MRI at 24 weeks revealed a macroadenoma of 15x17x17,8 mm. Also, in the 1st trimester, gestational diabetes mellitus was diagnosed; diet therapy was prescribed, and later in the 3rd trimester, insulin therapy was initiated. Delivery was at 41 weeks via cesarean section, without complications. One month later MRI showed a little increase of macroadenoma 17x22x21 mm, IGF-1 487 ng/ml. The patient was advised to stop lactation and resume lanreotide therapy, but she refused and continued breastfeeding. After 8 months she noted a decrease in vision and headache, IGF-1 increased up to 810 ng/ml. Computer perimetry showed scotomas in the superotemporal quadrant, on MRI adenoma 19x25x22 mm with chiasm compression. Repeat neurosurgical treatment was recommended.ConclusionThis clinical case demonstrates the possibility of pregnancy occurring even despite an aggressive course of acromegaly that was resistant to combined (surgery and lanreotide) treatment. An interesting fact is the lack of disease progression during pregnancy and the rather rapid deterioration after delivery. This may serve as a basis for more rigorous monitoring of disease activity postpartum and highlights the importance of lactation cessation if therapy needs to be resumed.

Clinical caseA 58-year-old male patient referred to an endocrinologist due to elevated blood glucose levels. The examination revealed changes in his appearance. Laboratory FINDINGS: IGF-1 720 (89-255) ng/mL; GH 10.7 ng/mL; Glucose 8.09 mmol/L; HbA1c 7.4%. An MRI revealed a pituitary tumor 13x12x13 mm with infra-suprasellar and left-sided parasellar extension. Colonoscopy revealed a superficial epithelial neoplasm of the ascending colon, histological examination – a tubulovillous colon adenoma. Active acromegaly and diabetes mellitus as well as colon polyp were diagnosed. The recommended surgical treatment (pituitary adenomectomy, polypectomy) was not performed due to COVID-19.At the age of 60, the patient was re-examined: GH 21.1 ng/mL; IGF-1 582 ng/mL; Glucose 7.68 mmol/L; HbA1c 6.44%. The pituitary MRI was without changes. A colonoscopy revealed a malignant transformation of the neoplasm in the ascending colon. The decision was made to alter the treatment strategy and postpone neurosurgical treatment for acromegaly, initiating somatostatin analogs instead. The patient underwent a laparoscopic right hemicolectomy. Follow-up examinations at 3 and 6 months showed no signs of cancer recurrence. During the same period, control of acromegaly was not achieved (IGF-1 level 721 ng/mL). Transsphenoidal adenomectomy was performed, and 6 months later (patient age 61), the IGF-1 level was 258 ng/mL; Glucose 6.9 mmol/L; HbA1c 6.5%.Discussion. Over a long period (more than 5 years) with active acromegaly and elevated GH and IGF-1 levels, the patient showed no negative dynamics in the size of the somatotropinoma, and his type 2 diabetes mellitus and arterial hypertension did not progress (with ongoing medical treatment). However, the increase in size of the colonic lesion in the ascending colon was noted and dynamic histological examinations allowed for the detection of malignant transformation of the colonic epithelial lesion that timely changed treatment tactics.ConclusionThis clinical case demonstrates the necessity of performing a full range of examinations (including colonoscopy) in a patient with active acromegaly and emphasizes the need for managing patients with acromegaly in multidisciplinary institutions.

IntroductionNeurofibromatosis type 1 (NF1) is one of the most common genodermatoses, and it can be associated with pheochromocytoma (PСC) in approximately 7% of cases. We present a case of postmortem diagnosis of PCC in female patient with undiagnosed NF-1.Clinical caseFemale patient had more than six skin café-au-lait macules, axillary freckling and small multiple subcutaneous neurofibromas that did not cause any inconvenience to her, so she did not complain, and GP did not pay attention to it. Since age 40, GP noted episodes of increased blood pressure (BP) up to 160/90 mm Hg when the patient referred with a cold but usually BP was 120/80 mm Hg so it was interpreted as vascular reaction to the flue. After 2 years at age 42 the patient had a deterioration of her condition with fatigue, increased BP up to 200/100 mm Hg, so standard antihypertensive therapy was initiated – during monitoring BP was 120/80mm Hg. One year after, the patient was urgently hospitalized with severe weakness, headache and BP 200/110 mm Hg that was resistant to intensive antihypertensive therapy, an extensive hematoma in the right lumbar region was noted. Then BP dropped to 90/80 mm Hg precipitously, the patient experienced epigastric pain and syncope. CT scan revealed a heterogeneous retroperitoneal mass, interpreted as a right retroperitoneal hematoma. However, during repeated laparotomies the bleeding source was not identified, the tissues were impregnated with blood and there were no visible signs of tumor, small multiple gastrointestinal stromal tumors were found. Despite intensive medical treatment, patient’s condition deteriorated into multi-organ failure and sepsis, and she died. Postmortem histological examination revealed a right adrenal pheochromocytoma infiltrating an adrenal vein, tumor was with huge hemorrhage that led to misunderstanding of CT-picture. Given the above-described skin changes, the patient was posthumously examined by a geneticist and diagnosis of NF-1 was confirmed.ConclusionA young female patient with clinical signs of neurofibromatosis type 1 experienced episodes of high BP that should have led to suspect a pheochromocytoma. Unfortunately, the diagnosis of NF-1 and a pheochromocytoma were overlooked. At the time of the final hospitalization, due to the patient's critical condition and massive ongoing therapy it was not possible to either confirm or rule out a pheochromocytoma. The clinical pictures and CT scans were characteristic to the hemorrhage, the tumor localization (high in the retroperitoneal space) and massive hemorrhage did not allow to identify the tumor even on laparoscopy. Thus, the delayed diagnosis of NF1 and its associated pheochromocytoma was the cause of the lethal outcome.