Background: The venous excess ultrasound score (VExUS) is used to objectify systemic venous congestion. The aim of the paper was to determine the association between VExUS grades and worsening renal function (WRF), reduced natriuretic response, diuretics resistance, and mortality in patients with acute heart failure (AHF). Methods: One hundred patients were included, and Doppler ultrasound of hepatic, portal, and renal veins was performed. Severity of congestion was graded using the VExUS score (grade 0, 1, 2, or 3). Sodium concentration in a spot urine sample was assessed in 2 h after the first loop diuretic administration and was adjusted for the prescribed dose of furosemide (31 mmol/40 mg). Diuretics resistance was defined as the need to double the starting dose of intravenous furosemide in 6 h. Results: Patients with VExUS grade 3 showed a higher incidence of WRF (OR: 11.17; 95% CI: 3.86–32.29; p < 0.001) and a decreased natriuretic response: a spot urine sodium content of <50 mmol/L (OR: 21.53; 95% CI: 5.32–87.06; p < 0.001) and an adjusted spot urine sodium content of <31 mmol/40 mg (OR: 9.05; 95% CI: 3.15–25.96; p < 0.001). The risk of diuretic resistance (OR: 15.31; 95% CI: 5.05–46.43; p < 0.001), as well as the need for inotropic and/or vasopressor support (OR: 11.82; 95% CI: 3.59–38.92; p < 0.001), was higher in patients with severe congestion. The hospital mortality rate increased in patients with VExUS grade 3 compared to in patients with other grades (OR: 26.4; 95% CI: 5.29–131.55; p < 0.001). Conclusions: Patients with AHF and VExUS grade 3 showed a higher risk of developing WRF, a decreased diuretic and natriuretic response, a need for inotropic and/or vasopressor support, and a poor prognosis during their hospital stay.

The use of anabolic androgenic steroids (AAS) in supraphysiologic doses is associated with a number of adverse effects on the cardiovascular system. In the presented clinical case, a bodybuilder athlete abusing AAS developed heart failure with a decrease in left ventricular ejection fraction of up to 20%. The peculiarity of the case is the recovery of left ventricular ejection fraction under the influence of drug therapy and withdrawal from AAS use with subsequent decrease after resumption of drug intake. In this case, we observed two types of myocardial damage – both ischemic and non-ischemic.

Background — Chronic heart failure with preserved ejection fraction (CHFpEF) develops as a result of many diseases that lead to significant metabolic disorders. Given the heterogeneity of this group of patients, therapeutic options for this syndrome are extremely limited. In this regard, it seems promising to study the metabolomic profile in patients with CHFpEF to identify biomarkers, examine their roles in the pathogenesis of the syndrome, and search for potential targets for targeted therapy. Objective — The study aimed at testing the correlation between the threonine level and the features of the clinical course of CHFpEF. Methods — The study included a total of 154 patients: 82 with CHFpEF, 45 with hypertension and/or coronary artery disease (comparison group), and 27 healthy volunteers (control group). Threonine levels were assessed using high-performance liquid chromatography-mass spectrometry. Results — The threonine concentration was significantly reduced in patients with CHFpEF (1) vs. comparison group (2) and control group (3): p<0.001; p1-3<0.001; p2-3=0.037). A reduction in the threonine level was characteristic for patients with diabetes mellitus vs. patients without it (p=0.029). Conclusion — Given the importance of threonine in energy metabolism and significant changes in its level in various pathophysiological processes, it should be considered as an additional diagnostic and prognostic criterion for CHFpEF. Additional studies are needed to better understand the role of threonine in the pathophysiology of cardiovascular diseases.

Fever of unknown origin (FUO), despite the wide diagnostic potential of modern medicine, remains a difficult problem for clinicians. Often, making a correct diagnosis requires a comprehensive examination of the patient, as well as the joint work of doctors from different specialties. A 57-year-old male patient was hospitalized due to an episode of loss of consciousness, unmotivated weight loss and daily evening temperature rises to 38-39 ^о C, accompanied by chills and increased sweating. Previously, he was examined by a general practitioner, a cardiologist, and repeatedly by a hematologist. There was no evidence of an infectious disease, arrhythmias, multiple myeloma, lymphoproliferative disorders. Monoclonal gammopathy of undetermined significance (MGUS) was diagnosed. Blood tests revealed neutrophilia (9800 cells/ μl) and moderate anemia. The patient was hospitalized to determine the FUO cause. Heart auscultation revealed a systolic murmur in the mitral valve, which was previously absent. Echocardiography revealed a mobile masses on the mitral valve, severe mitral regurgitation, and therefore infective endocarditis was diagnosed. Empirical antibiotic therapy with ceftriaxone and levofloxacin was administered. Further blood culture revealed growth of a HACEK representative Aggregatibacter actinomycetemcomitans , sensitive to both drugs. Examination established the odontogenic nature of endocarditis. During treatment, stable normothermia and significant blood count improvement were achieved. However, fluoroquinolone therapy led to tendinopathy. Due to persistent grade 3 mitral regurgitation, the patient underwent routine mitral valve replacement. Further follow-up revealed satisfactory condition of the patient. A feature of this case is the atypical course of infective endocarditis, occurring under a hematological mask, which made its diagnosis difficult. When examining a FUO patient, infective endocarditis should be included in the range of possible causes, taking into account not only the typical clinical picture, but also the numerous masks of this disease.

Background: Botulism is a life-threatening neuroparalytic disease caused by botulinum neurotoxins. While its acute phase has been extensively studied, long-term sequelae following recovery remain insufficiently explored. This systematic review aims to comprehensively assess and synthesize available evidence on post-botulism sequelae to improve understanding and guide future research. Methods: A systematic search was conducted in MEDLINE, EMBASE via Ovid, and Web of Science from inception to 24 June 2024. Eligible studies included observational studies, case series, and case reports describing post-recovery symptoms in individuals diagnosed with foodborne, wound, or infant botulism, excluding iatrogenic cases. The risk of bias was assessed using the Critical Appraisal Skills Programme (CASP) checklists. Results: Out of 340 screened records, 9 studies met inclusion criteria, comprising 2 case-control studies (n = 230 botulism cases, n = 669 controls) and 7 cohort studies (n = 185 botulism cases). Most studies reported some short- and/or long-term consequences of botulism. Among 3 studies homogeneously reporting sequelae symptomatology, the most frequently reported long-term symptoms included fatigue (66.2%, range 47.9%–84.6%), limitations in vigorous activities (55.8%, range 47.6%–64.0%), general weakness (57.1%, range 43.1%–76.9%), and dyspnea (42.9%, range 18.0%–92.3%). In some patients, psychosocial dysfunction persisted longer than physical impairments, over the 6-year period post intoxication. Two studies provided comparative data with control groups, demonstrating significantly higher prevalence of fatigue, weakness, and impaired health perception in botulism survivors. Additionally, 14 case reports and case series (n = 43 individuals) reported similar patterns with dyspnea, fatigue, and autonomic dysfunction among the most reported sequelae. Conclusions: This systematic review highlights significant long-term sequelae among botulism survivors, particularly fatigue, respiratory impairment, and psychosocial dysfunction. While recovery trajectories suggest improvement over time, persistent symptoms may impact quality of life. Standardized outcome measures and longitudinal studies are needed to elucidate the burden of post-botulism sequelae further and inform clinical management strategies.

Background: Risk stratification for adverse cardiovascular outcomes is a key challenge in clinical cardiology. In addition to traditional risk scores, various other markers, including circulating microRNAs, have been actively investigated in recent years as a potential tool for personalized prognosis. Aim: To assess the prognostic value of baseline microRNA levels in patients with asymptomatic coronary atherosclerosis detected by multislice computed tomography (MSCT) during long-term follow-up. Methods: The retrospective analysis included data from 30 patients with asymptomatic coronary atherosclerosis confirmed by MSCT. At baseline, plasma levels of 15 circulating microRNAs were measured in all patients using NucleoSpin miRNA Plasma kits (MACHEREY-NAGEL, Germany): miR-195p, miR-126-3p, miR-205-5p, miR-126-5p, miR-21-5p, miR-143-3p, miR-223-3p, miR-145-5p, miR-29b-3p, miR-146a-5p, miR-92a-3p, miR-150-5p, miR-23a-3p, miR-181b-5p, miR-451a. Information on clinical outcomes within 5 years after enrollment was obtained from the Unified State Health Information System (USHIS, Russia). Endpoints were acute myocardial infarction (AMI), stroke, all-cause mortality, and a composite endpoint (AMI / stroke / mortality). Results: Among the 30 patients with asymptomatic atherosclerosis on MSCT (mean age 70 ± 9.8 years, 11 men), adverse outcomes were recorded in 7 patients during the 5-year follow-up, while 23 patients remained event-free. In univariate Cox analysis, only two microRNAs showed a statistically significant association with the outcome (AMI, stroke, and all-cause mortality): for miR-143-3p, the hazard ratio (HR) was 0.724 (95% confidence interval [CI] 0.539–0.972; p = 0.032); for miR-451a, HR was 27.872 (95% CI 1.125–690.637; p = 0.042). ROC analysis revealed borderline significance in predicting adverse events for miR-143-3p (sensitivity 71.4%, specificity 73.9%; p = 0.059) and for miR-451a (sensitivity 71.4%, specificity 87.0%; p = 0.066). In multivariable Cox regression adjusted for the Framingham risk score, a higher miR-143-3p level was independently associated with a reduced risk of all-cause death (HR 0.71; 95% CI 0.52–0.96). After adjustment for the Multi-Ethnic Study of Atherosclerosis (MESA) risk score, the high-risk category of miR-143-3p was associated with an increased risk of reaching the composite endpoint (HR 607.997; 95% CI 4.606–8024.582). Conclusion: Among the 15 microRNAs studied, miR-143-3p and miR-451a demonstrated an association with the development of adverse outcomes in patients with asymptomatic coronary atherosclerosis. These findings point to the potential prognostic value of these microRNAs, but require confirmation in studies with larger patient samples.