As known, the clinical efficacy of chemotherapy is limited by the cardiotoxicity of drugs used. The study aimed to clarify cardiotoxic complications of chemotherapy from the Aktobe Medical Center database for 2018-2019. Material and methods: We performed a register study on essential parameters of the oncological process, drugs used, duration of chemotherapy, types of complications, and outcomes, including survival. Results: We found a total of 305 breast cancer cases. Chemotherapy was completed without complications in 65.9% of patients; treatment was interrupted due to complications - 10.5%; 6.2% of cardiovascular complications were identified. The two groups of patients, EchoCG + and EchoCG -, showed significant difference in the number of detected CV complications (p<.001) but no difference in the survival rate (p .814). The survival rate in patients with documented CV complications was 28.1 months vs. 34.3 months in the group without ones (p.005). The survival rate in those who completed the treatment without complications, was 34.9 months vs. 17.6 in individuals whose treatment was interrupted due to complications (p<.001). We performed a detailed review of four cases of cardiotoxicity with fatal outcomes. Conclusion: The analysis indicates the absence of a systematic approach to recording crucial information regarding cardiotoxicity. There is a lack of concordance in the actions of cardiologists and oncologists in the management of BC patients. The presence of lethal outcomes of chemotherapy with an established cause of cardiac death indicates the need to revise the cancer register management from the standpoint of cardio-oncology. In general, there is a need to develop local protocols for screening and monitoring patients undergoing cardiotoxic chemotherapy and radiation therapy.

A majority of modern antitumor pharmaceuticals are accompanied by cardiotoxicity. The study aims to present practical approaches to stratifying the baseline risk of antitumor therapies' cardiotoxicity in patients newly diagnosed with breast cancer started on anthracyclines and/or trastuzumab. Material and methods: Stratifying the risks of antitumor therapy was carried out according to the European Society of Cardiology recommendations. A therapist examined all patients for existing cardiovascular diseases and risk factors detection. The blood levels of glucose, cholesterol, creatinine, cardiac troponin I, and brain natriuretic peptide were determined. Electrocardiography and echocardiography with an assessment of the myocardium global longitudinal strain were performed. Results: In total, 128 breast cancer patients with a mean age of 54.3±11.0 years were included in the study. Of them, 84.4% had tumor stages I and II, and 21.1% were HER2-positive. Chronic heart failure and ischemic heart disease were detected in 2.3%. Among the risk factors, the most common were arterial hypertension (51.6%), obesity (29.7%), age 65-70 years (18%), significant smoking history (15.6%), and diabetes mellitus (11.7%). Elevated cardiac troponin I and brain natriuretic peptide baseline levels were present in 5.5% and 7.0% of patients, respectively. To a high-risk group for cardiotoxic complications, 7.8% were allocated, 35.7% were assigned to the moderate-risk group, and 54.7% had low risk. High/very high and moderate-risk patients (43.5%) were referred to a cardiologist. Cardioprotective treatment was started immediately in high/very high-risk patients. Conclusion: All revealed differences between the cardiovascular risk groups were related to age, cardiovascular system condition, and the severity of comorbid pathologies. The baseline stratification of patients into risk groups is a crucial step in preventing the cardiotoxicity of anticancer therapy. Comprehensive assessing the patient's condition before and during chemotherapy allows for avoiding the development of fatal cardiovascular complications in at-risk patients.

Введение. Рак молочной железы является чувствительным к определенным схемам химиотерапии, которые оказывают агрессивное действие на сердце и сосуды. Выделяют антрациклин - опосредованную необратимую кардиотоксичность первого типа и трастузумаб - опосредованную обратимую кардиотоксичность второго типа. Определение сывороточных биомаркеров является альтерантивным подходом для ранней оценки дисфункции миокарда. Цель: анализ прогностической значимости тропонина для раннего выявления кардиотоксических осложнений антрациклина и/или трастузумаба у больных раком молочной железы. Стратегия поиска. Поиск осуществлялся в базах данных Pubmed, Web of Science, Scopus, eLIBRARY. Критериями для включения исследований в обзор были: рандомизированные клинические и проспективные исследования, датированные 2010 - 2020 гг.Использовались ключевые слова по следующим разделам: патология: «breast cancer», «breast»; лечение: «antracycline» «trastuzumab», «chemotherapy»; биомаркеры: «troponin», «troponin I», «troponin T», «high sensitive troponin»; осложнения химиотерапии: «cardiotoxicity», исследования: «controlled trial», «randomized controlled trial», «controlled clinical trial», «clinical trial». Отбор исследований производился методом триангуляции. Всего в обзор вошли 27 полнотекстовых исследований, полностью соответствующих критериям поиска. В списке литературы указаны также работы, не соответствовавшие критериям поиска, но иллюстрирующие актуальность темы. Результаты. Повышение уровня тропонина является признаком развития сердечной дисфункции с неблагоприятным прогнозом, особенно при продолжающемся росте уровня тропонина. Прирост уровня тропонина и интеграл прироста от базового уровня являются более надежными предикторами, чем абсолютное значение тропонина. Выводы.Пациенты с РМЖ, получающие терапию антрациклинами и последующую терапию таргетными препаратами имеют наибольшый риск развития кардиотоксических осложнений. Мониторирование уровня тропонина имеет прогностический потенциал и должно проводиться всем пациентам. Панель биомаркеров с включением тропонина может быть более полезной для раннего обнаружения дисфункции миокарда. ntroduction. Breast cancer is sensitive to some schemes of chemotherapy known to be aggressive towards the cardiovascular system. There is anthracycline-mediated irreversible cardiotoxicity of the first type and trastuzumab-mediated reversible cardiotoxicity of the second type. The use of serum biomarkers capable of detecting myocardial injury before symptoms appear is an alternative approach to early diagnosis of the chemotherapy cardiotoxic complications. Aim: analyze the prognostic value of troponin for the early detection of cardiotoxic complications caused by anthracycline and/or trastuzumab in breast cancer patients. Search strategy: The search was carried out across the databases Pubmed, Web of Science, Scopus, e-LIBRARY. Criteria for inclusion in the review were: randomized controlled trials and prospective studies dated 2010–2020. The keywords were used according to the following sections: pathology: "breast cancer", "breast"; treatment: «anthracyclines», «trastuzumab», «chemotherapy»; biomarkers: «troponin», «troponin I», «troponin T», «high sensitive troponin»; complications of chemotherapy: "cardiotoxicity", studies: "controlled trial", "randomized controlled trial", "controlled clinical trial", "clinical trial". The selection of studies was carried out by the triangulation method. In total, the review included full-text 27 studies that completely met the search criteria. The list of references also contains researches that did not meet the search criteria, but illustrating the relevance of the topic. Results. An increase in troponin levels may signify the development of cardiac dysfunction with a poor prognosis, especially if troponin levels continue to rise. The increase in the hs-troponin and the integral of the increase are more reliable predictors than the absolute value of troponin. Сonclusions. Breast cancer patients receiving anthracyclines and subsequent targeted chimiotherapy have the highest risk of cardiotoxic complications. Troponin level monitoring has predictive potential and should be considered to all patients receiving chemotherapy. Troponin and the combination of several markers may turn out to be more sensitive in predicting...

This publication presents a clinical case of infectious endocarditis in an adult male aged 60, with manifestation of the disease in the form of spondilodiscitis. The presented observation demonstrates the development of onset of infectious endocarditis of bacterial spondylodiscitis in the adult patient. For a long time the patient’s intensive pain in the lumbar region could not be connected with infective endocarditis. According to the results of the examination the changes in the spine were not evaluated as an onset of IE. Dynamic observation and control MRT study allowed for the conclusion about bacterial spondilodiscitis in our patient with IE and to connect these two processes. In such clinical cases, MRT of the spine or positron emission tomography combined with computed tomography using a radiopharmaceutical 18F-fluorodeoxyglucose (F-FDG- PET / CT) of the whole body is recommended. In the case of a specific spondilodiscitis, the continuation of antibacterial therapy is determined by signs of inflammatory activity on F-FDG-PET / CT or MRT of the spine.

Background: Poor sleep quality is an increasingly recognized, modifiable cardiovascular risk factor, yet data among patients with established coronary heart disease (CHD) in Central Asia are scarce. We estimated the prevalence of poor sleep quality and identified its correlates in a Kazakhstani CHD population. Methods: In this multi-center cross-sectional study, 398 patients 6–24 months after an index coronary event were assessed for sleep quality. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI; >5 = poor). Anxiety and depression, physical activity, cognition, and clinical and socio-demographic variables were recorded. Associations were examined using logistic regression with subgroup and interaction analyses. Results: Poor sleep quality was reported by 147 patients (36.9%). In the adjusted model, anxiety was the only independent factor associated with poor sleep (OR 1.88, 95% CI: 1.10 to 3.23). The subgroup analysis suggested anxiety (OR 3.94) and lower education (OR 2.58) as correlates in women, whereas retirement (OR 2.27) and low physical activity (OR 2.31) were linked to poor sleep in men. A significant sex–anxiety interaction demonstrated a weaker anxiety effect in men. Conclusions: More than one-third of CHD patients reported poor sleep quality, driven primarily by anxiety, with distinct sex- and age-specific determinants. Sleep and psychological screening should be integrated into secondary prevention, with personalized approaches.

Aim. To conduct a survey among doctors in 4 countries of the Com­mon­wealth of Independent States (CIS) to assess the effectiveness of se­condary prevention of noncommunicable diseases in outpatient health­care.Material and methods. Outpatient healthcare physicians from 6 cities in 4 neighboring countries participated in the cross-sectional study. A total of 210 physicians of the internal medicine profile took part in the survey: Bishkek (Kyrgyzstan) — 42 physicians, Minsk (Belarus) — 37 physicians, Astana, Shymkent, Aktobe (Kazakhstan) — 55, 30, 10 physicians, respectively, Baku (Azerbaijan) — 36 physicians. The survey was carried out using an original questionnaire of the National Medical Research Center for Therapy and Preventive Medicine, which consisted of 11 blocks of questions. Answers in several gradations were offered for each question.Results. In 3 countries, among men who sought primary care in health care institutions, patients in the age range of 50-59 years prevailed, while in Azerbaijan, men aged 60-65 years dominated. In the CIS countries, patients most often seek medical attention at a outpatient clinic due to chronic coronary artery disease. In Azerbaijan, Kazakhstan and Belarus, the number of patients with type 2 diabetes with or without complications is >20%. Doctors in large cities of the CIS countries do not recommend non-drug treatment methods in up to 10% of cases. Subsidized pharmaceutical provision varies slightly between the analyzed cities. In Kazakhstan and Belarus, 70% of doctors note reaching 75% of the target indicators. In Kyrgyzstan and Azerbaijan, a similar level is achieved 2-3 times less often. In Kazakhstan, Belarus and Kyrgyzstan, a relatively high frequency is noted (satisfaction in 75% of cases), while Azerbaijani doctors claim that 52% are dissatisfied and 44% are partially satisfied with the interaction with specialized hospital-based doctors. In Azerbaijan and Belarus, 75% staffing of outpatient doctors in medical and preventive institutions prevails. In Kyrgyzstan, 100% staffing is detected in 84% of cases. At the same time, in Kazakhstan, 50% and 75% staffing has a comparable frequency. In these countries, a similar picture is observed in terms of provision of mid-level outpatient health workers.Conclusion. Among patients with noncommunicable diseases ob­served in outpatient clinics, patients with coronary heart disease and type 2 diabetes predominate. Adherence to therapy in every second case is at an insufficient level. Coverage of subsidized drugs and achievement of target levels of the main risk factors among patients is on average 60% of cases. In 3 of the 4 analyzed CIS countries, there are problems with staffing with doctors and medical staff.