Aim. To provide a hygienic assessment of dietary silicon intake among the adult population of the Omsk Region. Materials and Methods. In 2023, a cross-sectional observational epidemiological study was conducted in a representative sample (n = 506) of adults aged 18 to 83 years (231 men and 275 women; median age – 45 [32; 59] years). Dietary silicon intake was assessed in a cross-sectional observational epidemiological study. using food frequency data and a custom database of silicon content in food products. Results. The median daily dietary silicon intake in the representative sample was 32.3 (23.6; 41.7) mg/day. No individuals were identified with silicon intake below 5 mg/day or above 500 mg/day during the study period. There were no statistically significant differences in silicon intake between men and women (p = 0.8356) or across age groups (p = 0.102). However, a slight trend of increasing silicon intake with age was observed. The proportion of adults with intake below the adequate level of 30 mg/day was 13.2 ± 1.51%, including 13.85 ± 2.27% among men and 12.73 ± 2.01% among women. With increasing age, the share of individuals with insufficient intake decreased (p = 0.102), although older women were more likely to have lower intake compared to men. The main dietary sources of silicon were: vegetables (tomatoes, cucumbers, vegetable soups) – 41.9%, beverages (tea, coffee) – 30.3%, and bakery products (rye bread) – 10.6%. Conclusion. The daily dietary intake of silicon among adults in the Omsk Region corresponds to an adequate level. No cases of intake associated with health risk due to deficiency or excessive consumption were identified. The proportion of the population with intake below the adequate level reflects the general silicon sufficiency in this population. Currently, silicon is not considered a priority micronutrient for nutritional intervention in the Omsk Region

Aim. To assess the impact of implementing evidencebased cardiology guidelines into the clinical practice in the Russian Federation and selected European countries on trends in cardiovascular disease (CVD) mortality. Materials and Methods. Mortality data were obtained from the Global Burden of Disease database. Countries were grouped into five clusters based on CVD mortality rates. Information on implemented clinical guidelines was gathered from professional society websites and published national and international sources. We further conduced an epidemiological analysis of CVD mortality before and after the implementation of clinical guidelines, including before-after analysis of mortality trends. Results. After the implementation of clinical cardiology guidelines, a reduction in CVD mortality was observed in Spain, Estonia, Russia, Latvia, Belarus, Ukraine, and especially United Kingdom and the Netherlands. Decrease in mortality in Belgium, France, Slovakia, Italy, Portugal, Germany, and the Czech Republic was associated with successful CVD prevention campaigns and active use of clinical cardiology guidelines in clinical practice. Increased mortality in Croatia, Serbia, Bosnia and Herzegovina, Lithuania, Romania, and Bulgaria was linked to limited economic resources that hindered full implementation of preventive and treatment programs. Conclusion. The integration of CVD clinical guidelines into the national healthcare systems has played a significant role in reducing mortality. Achieving the full potential of CG implementation requires a comprehensive strategy that ensures access to quality care for the entire population, including preventive and rehabilitation programs, sufficient funding, modern infrastructure, and continuous professional development of healthcare personnel. Systemic integration of guideline-based prevention, diagnostics, and treatment can further reduce CVD morbidity and mortality

Aim. To identify occupational risks of bloodborne infections among healthcare workers in order to develop effective risk management strategies. Materials and methods. Investigation reports and incident records were analyzed for 3,256 occupational exposure events involving healthcare workers in Sverdlovsk Region from 2013 to 2023. Results. From 2013 to 2023, the incidence rate of blood exposure incidents among healthcare workers was 6.6 per 1,000 (95% CI: 6.1– 7.1). The risk varied depending on the type of medical department, the nature of medical procedures, job role, length of professional experience, day of the week, and time of day. The highest risk of occupational infection was observed among surgeons, traumatologists, obstetrician-gynecologists, anesthesiologists-resuscitators, nurses performing invasive procedures, and staff involved in medical waste collection and transportation. Incidents most commonly occurred during surgeries, injections, and waste handling. The most frequent injury type was hand needlestick injury (81.6%), with 72.3% caused by injection needles. On average, 44.1% of incidents posed a moderate risk of HIV or viral hepatitis transmission, and 9.2% carried a high risk. Post-exposure antiretroviral prophylaxis for HIV was provided to 91.0% of those who required it. Of the healthcare workers, those at the highest risk of contracting blood-borne infections were surgeons and traumatologists, obstetricians and gynecologists, anesthesiologists and resuscitators, nurses performing invasive procedures, and employees involved in the collection and transportation of medical waste. Emergencies most often occurred during surgical interventions, injections, and when working with medical waste. By the nature of the traumatic factor, hand pricks were predominant (81.6%), including 72.3% with injection needles. On average, 44.1% of emergency situations were associated with a moderate risk of HIV and viral hepatitis infection, and 9.2% with a high risk. Coverage of post-exposure antiretroviral therapy for HIV infection among all employees who needed it was 91.0%. Conclusion. The analysis of blood exposure incidents is a critical tool for monitoring and managing occupational risks of bloodborne infections among healthcare workers. A comprehensive, multifaceted strategy is required to reduce the risk of injuries and infections.

Aim. To study the types of vaginal microbial communities in women with high-grade squamous intraepithelial lesion (HSIL) and those negative for intraepithelial lesion or malignancy (NILM). Materials and Methods. Between 2021 and 2023, we conducted an analysis of vaginal microbial community types among 70 women of reproductive age infected with high-risk oncogenic HPV: those with HSIL verified by cytological examination (n = 40) and those without precancerous cervical lesions (i.e., NILM, n = 30). Identification of microorganisms in the cervical mucus was identified by mass spectrometry. Results. The frequency of normal microbiota detected by the microscopic examination was 5.3-fold lower, whilst Streptococcus spp. was detected 3-fold times higher in women with HSIL compared to the NILM group (p = 0.023). Among patients with HSIL, community state type (CST) IV was the most frequent (75%), and CST IV-C1 subtype (with Streptococcus spp. as a prevailing genus) was found in 25% of cases (p = 0.132). In patients with NILM, CST IV was also the predominant type (60%) but CST IV-C2 (with Enterococcus spp. as a prevailing genus) was most frequent subtype (23.3%, p = 0.087). The prevalence of HPV type 16 and grade 2 abnormal colposcopy findings were 3.9-fold (p = 0.008) and 3.5-fold (p = 0.040) higher in women with HSIL than in NILM (p = 0.008). Conclusion. The predominant type among vaginal microbial communities in women with HSIL and NILM was CST IV, with C1 and C2 subtypes prevailing respectively in HSIL and NILM

Aim. To summarize factors that may lead to premature rupture of membranes through the literature analysis. Materials and Methods. A search was conducted in the PubMed database using the keywords: "prelabor rupture of membranes" and "premature rupture of membranes." A total of 1,287 sources were identified. After removing 256 duplicate records, a screening process was carried out. Based on title and abstract review, 624 studies were excluded. Following full-text analysis, 198 studies were excluded due to lack of relevance to the review topic, and an additional 62 publications were excluded due to unavailability of full-text access. In total, 54 publications met the inclusion criteria. The search covered the past 5 years (2019–2024). Results. The analysis addressed risk factors associated with infection, metabolic syndrome, the influence of biologically active substances, and endothelial dysfunction. Conclusion. At present, there is no unified understanding of the pathogenesis of premature rupture of membranes. The infectious and endothelial theories appear to be the most promising; however, neither fully explains the processes involved in the development or mechanisms underlying this complication. The risk factors described in the literature are highly heterogeneous and do not conform to a single conceptual framework

Aim. To describe a pathogenetic rationale for obstetric and perinatal complications associated with metabolic syndrome. Materials and Methods. This is a descriptive review based on original research and review articles on obstetric and perinatal complications in the context of metabolic syndrome, published between 2016 and 2025 and indexed in PubMed, ScienceDirect, and eLibrary databases. The following research methods were employed: internet-based analysis, content analysis, historical method, and descriptive-analytical approach. Results. Obesity and metabolic syndrome have a negative impact on maternal and fetal outcomes. Adipose tissue functions as an active endocrine organ that regulates vascular, metabolic, and inflammatory processes across multiple organ systems, thereby affecting obstetric and perinatal outcomes. Conclusion. The obesity epidemic has drawn attention to adipose tissue as a critical regulator of systemic nutrient and energy homeostasis. In metabolic syndrome, adipose tissue must adapt to excessive lipid load through a variety of strategies, including increasing adipocyte size and number, altering immune cell composition, and reshaping lipid metabolism. Failure to adequately adapt to increased nutritional load results in adipose tissue dysfunction which triggers a cascade of lipotoxic effects on other organs, leading to insulin resistance, diabetes mellitus, and related metabolic complications. Adipose tissue dysfunction is significantly accelerated by the additional metabolic load imposed by pregnancy

Aim. To evaluate the clinical course of stable coronary artery disease (CAD) depending on the timing of disease onset in relation to COVID-19 infection, and to identify predictors of disease progression during the post-COVID period. Materials and Methods. This study included 431 patients with stable CAD who had a confirmed history of COVID-19 between 2020 and 2023, with a minimum of 3 months between infection and enrollment. Patients were divided into two groups based on the timing of CAD diagnosis: patients diagnosed with CAD in the post-COVID period (n = 198, post-COVID-CAD) and patients diagnosed with CAD before their COVID-19 infection (n = 233, pre- COVID-CAD). We further evaluated clinical and laboratory parameters, including lipid profile (apolipoprotein A1, apolipoprotein B, lipoprotein( a)), N-terminal pro-brain natriuretic peptide (NT-proBNP), ST2, and coronary angiography. Logistic regression analysis was used to identify predictors of CAD progression. Results. Patients with pre- COVID-CAD were older (median age 62 vs. 61 years, p = 0.009), had a higher body mass index (BMI: 31.02 vs. 28.73 kg/m², p < 0.001), and a longer history of arterial hypertension (15 vs. 9.5 years, p < 0.001). COVID-19 was more severe in patients with pre-COVID-CAD, with a higher hospitalization rate (50.2% vs. 37.8%, p = 0.012) and more frequent moderate cases during the acute phase (58.7% vs. 45.9%, p < 0.009). Patients with pre-COVID-CAD also had a higher prevalence of prior myocardial infarction (51.0% vs. 26.7%, p < 0.001) and hemodynamically significant coronary artery lesions (86.2% vs. 67.6%, p < 0.001). Conversely, normal coronary arteries were more often observed in patients with post-COVID-CAD (8.5% vs. 7.2%, p = 0.003), possibly indicating microvascular involvement in post-COVID-CAD pathogenesis. Multifocal atherosclerosis was prevalent in both groups (75.7% vs. 79.8%, p = 0.351). Heart failure with mildly reduced ejection fraction (HFmrEF) was more common in patients with pre-COVID-CAD (10.7% vs. 5.0%, p = 0.034), whereas heart failure with preserved ejection fraction (HFpEF) predominated in patients with post-COVIDCAD (94.9% vs. 89.2%, p = 0.034). Left ventricular ejection fraction and glomerular filtration rate were significantly lower in patients with pre-COVID-CAD (60% vs. 62%, p = 0.007; 63.0 vs. 67.5 mL/min/1.73 m², p < 0.001, respectively). Laboratory indicators such as triglycerides, Lp(a), apoB, uric acid, and cystatin C were significantly elevated in patients with pre-COVID-CAD (p < 0.05). Multivariate analysis identified the following significant predictors of CAD progression in the post-COVID period: angina duration > 2.5 years, BMI > 29.66 kg/m², a history of moderate COVID-19, Lp(a) > 317.6 mg/dL, and NT-proBNP > 161.04 pg/mL. Conclusion. The timing of CAD onset in relation to COVID-19 significantly influences the disease course, emphasizing the need for a differentiated management strategy in post-COVID patients to predict CAD progression

Aim. This study aims to conduct a comparative analysis of anticoagulant-related complications and clinical outcomes in patients with mechanical aortic valve prostheses who are on long-term warfarin therapy. The analysis will focus on two groups: those maintained at therapeutic INR values (3 ± 0.5) and those maintained at reduced INR values (2 ± 0.5). Material and methods. The analysis of a prospective, randomized, single-center study included 80 patients (56% men and 44% women) who underwent mechanical aortic valve replacement between March 2020 and September 2022. The observation period lasted 12 months, with an average age of 59 years (range: 50-63). The primary endpoint was a composite outcome measured over 12 months, consisting of death, symptomatic bleeding, thrombosis, and thromboembolism. Patients were enrolled based on the following inclusion criteria: mechanical prosthesis in the aortic position implanted more than three months prior, age over 18 at the time of inclusion, and provision of written informed consent. Exclusion criteria included multivalvular prosthetics, history of cardiac cavity thrombosis, left ventricular ejection fraction of less than 30%, atrial fibrillation/flutter, pregnancy or plans for pregnancy during the study, patient refusal at any stage of the study, liver pathology (types B and C according to Child- Pugh), and severe renal failure (creatinine clearance <30 ml/ min). Results. All participants (n = 80, 100%) completed the pilot study. Among the 40 patients in the study group, 6 (7.5%) experienced events related to the primary endpoint. The odds ratio for the primary endpoint at 12 months was 2.71 (p = 0.25). Additionally, the odds ratio for the primary endpoint at 18 months was calculated to be 3.35 (p = 0.155). Given the observed negative trend in the frequency of disabling events in the primary group, and despite the lack of statistically significant differences, the study was terminated at the pilot stage for ethical reasons. Conclusion. This study reveals a negative trend in the frequency of primary endpoint events among patients with reduced INR levels. Notably, the majority of these events consisted of ischemic strokes, which occurred in 5% of the study group. Consequently, the optimal target INR range for patients who have undergone heart valve replacement with mechanical prostheses remains inadequately defined

Aim. To demonstrate the feasibility and safety of performing cardiac surgery under cardiopulmonary bypass (CPB) in a child weighing 1.8 kg. Materials and Methods. We present a case of cardiovascular surgery under CPB in an infant with a body weight of 1.8 kg. Results. The major challenges associated with anesthetic management and CPB procedures are described, along with the strategies employed to overcome them in order to enable successful cardiac surgery. Laboratory and instrumental diagnostic indicators and vital parameters of perioperative monitoring are presented to demonstrate the safety of the procedures performed in this patient. Conclusion. Advances in current cardiovascular surgery and cardiac anesthesiology enable the performance of CPB-assisted operations in premature infants with low body weight. This article outlines the specific features of conducting cardiac surgery in a patient weighing 1.8 kg and provides evidence of its safety

Aim. To investigate neurodynamic parameters as markers of cognitive impairment in non-alcoholic fatty liver disease (NAFLD). Materials and Methods. Here we enrolled forty patients with NAFLD diagnosed by liver ultrasound findings, the presence of obesity or dyslipidemia, and absence of other causes of hepatic steatosis (i.e., alcohol use, drug-induced liver injury, environmental toxins, nutritional or intestinal disorders, endocrine diseases, and monogenic conditions). The laboratory investigation included a complete blood count, comprehensive biochemical panel (bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gammaglutamyl transferase, lipid profile, glucose, creatinine, urea, total protein and protein fractions, and prothrombin index). The non-invasive Fibrosis-4 (FIB-4) index was used to assess fibrosis severity. Alcohol misuse was screened using the Alcohol Use Disorders Identification Test (AUDIT). To exclude hepatic encephalopathy, the Reitan number connection test was performed. All patients were also evaluated using the Mini- Mental State Examination (MMSE) to detect dementia and pre-dementia cognitive impairments. Cognitive functions were assessed using the Status PF software with a reaction registration adapter developed at Kemerovo State University. Neurodynamic parameters included the complex visual-motor reaction time and response to a moving object. The control group consisted of 30 healthy volunteers matched by age and sex. Results. Patients with NAFLD, even in the absence of significant fibrosis or biochemical markers of inflammation, demonstrated altered neurodynamic parameters compared to the control group, and inhibition processes in the central nervous system prevailed. Conclusion. Patients with NAFLD exhibit cognitive deficits not associated with hepatocellular injury or hepatic encephalopathy. Central nervous dysfunction in hepatic steatosis reflects the complex multifactorial pathogenesis of the underlying disease and warrants further investigation

Aim. To assess chronic constipation as a pathogenetic factor in the development and exacerbation of dyslipidemia in elderly and senile patients, with a focus on mechanisms involving gut microbiota dysbiosis and endotoxemia. Materials and Methods. A systematic review was conducted following PRISMA guidelines using a study selection flowchart. Searches were performed in PubMed, Scopus, and Web of Science (2010-2024) using the keywords: “chronic constipation,” “dyslipidemia,” “elderly,” “gut microbiota,” “endotoxemia,” “lipid metabolism,” and their synonyms. Of 2,468 identified records, 31 studies were included after removing duplicates (n = 634) and irrelevant articles (n = 1,803). Included studies were original (cohort or crosssectional), reviews, and randomized controlled trials focusing on elderly (≥ 65 years) or mixed cohorts with extrapolated data. Study quality was assessed using the Newcastle–Ottawa Scale (NOS ≥5), ROBINS-I, and the Cochrane Risk of Bias Tool. A narrative data synthesis was applied. Results. Chronic constipation contributes to dysbiosis (i.e., decreased Firmicutes, increased Bacteroidetes, and reduced levels of shortchain fatty acids), which in turn increases intestinal permeability and metabolic endotoxemia (i.e., elevated circulating lipopolysaccharides, C-reactive protein, IL-6, and TNF-α). These changes disrupt lipid metabolism, leading to elevated low-density lipoprotein cholesterol levels that results in an increased risk of cardiovascular disease (coronary artery disease, myocardial infarction, and stroke) with a hazard ratio of 1.34. Dysbiosis may also increase the risk of key geriatric syndromes such as frailty syndrome and sarcopenia. Probiotic supplementation was associated with increased stool frequency (by 1.3 times/week), and polyphenol intake was linked to reduced zonulin levels and improved lipid profiles (decreased low-density lipoprotein cholesterol). Conclusion. Constipation in individuals over 65 years of age represents a systemic risk factor for dyslipidemia through its effects on dysbiosis and endotoxemia. Modulation of the gut microbiota with probiotics and polyphenols holds promise, but long-term clinical trials are needed to confirm these findings