Anatolii O. Rubanenko

Introduction . Currently, acoustic voice analysis in cases of vocal apparatus damage is being actively integrated into clinical practice as a novel diagnostic method. However, data on its effectiveness are not always unambiguous. There remains a lack of sufficient data regarding the analysis of speech biomarker changes across various pathologies. The objective was to determine the potential use of acoustic analysis parameters of the speech signal in diagnosing diseases associated with involvement of the vocal apparatus. Methods and materials. The information search was conducted in accordance with PRISMA guidelines in the following databases: PubMed, Google Scholar, Clinical Trials, CyberLeninka, and eLibrary. A total of 3 publications were selected for the final full-text analysis. These studies evaluated speech signal parameters in cases of organic and functional diseases of the vocal cords and thyroid dysfunction. The meta-analysis examined Jitter and Shimmer in pathological conditions compared to healthy volunteers. Results. The meta-analysis assessing the diagnostic potential of diseases accompanied by organic or functional damage to the vocal cords included 3 studies encompassing 180 patients and 194 healthy volunteers. The results of the meta-analysis demonstrated that both Jitter and Shimmer values in patients with vocal cord lesions were statistically significantly higher compared to healthy individuals (p=0.002). Conclusion. This systematic review and meta-analysis of studies have demonstrated that the application of acoustic voice analysis is feasible in diagnosing diseases associated with vocal apparatus damage.

Introduction:: The effectiveness of controlling blood pressure when prescribing a fixed combination (“polypill”) compared to monocomponent drugs has not been fully determined. According to the studies conducted, some demonstrate statistically significant differences in mean blood pressure levels when taking a “polypill” compared to monocomponent drugs, while others do not reveal this effect. The aim was to evaluate the efficacy of “polypill” in lowering blood pressure in patients with Cardiovascular (CV) diseases compared to monocomponent drugs. Methods:: The search was conducted according to PRISMA guidelines in PubMed, Google Scholar, and ClinicalTrials databases. Finally, 10 studies were selected. The dynamics of the mean systolic and diastolic pressure in patients taking “polypill” was evaluated in comparison to monocomponent drugs. Results:: During the identification stage, 568 publications were found. At the screening phase, 321 papers, such as books, reviews, systematic reviews, meta-analyses, etc were excluded. 168 papers were assessed for eligibility. After the eligibility assessment, 158 papers were excluded for deviations from the study design (e.g., no control group, no direct comparison between “polypill” and monocomponent drug therapy, data presented as median and interquartile range, placebo as the control group, etc.). In the final analysis, we included 10 publications that evaluated the effect of a fixed combination of medications (“polypill”) compared with monocomponent therapy on blood pressure. During further sub-analyses, 1 study was excluded. The meta-analysis of the clinical efficacy of “polypill” control of blood pressure was conducted in comparison with standard therapy and comprised 9 studies, involving patients with previous myocardial infarction, acute cerebrovascular accident, high CV risk, hypertension and dyslipidemia. In total, all of the studies enrolled 6264 people, of whom 3147 patients received “polypill”, and 3117 patients – monocomponent drugs. The meta-analysis demonstrated that fixed-dose combination therapy yielded a statistically significant difference compared to standard therapy with respect to its impact on systolic (standardized mean difference: -0.128; (-0.177; -0.08); p < 0.01) and diastolic (standardized mean difference: -0.171; (-0.233; -0.11); p < 0.01) blood pressure. Discussion:: The findings of the conducted meta-analysis support the evidence of beneficial switching to “polypill” therapy in patients with hypertension, especially in cases requiring a multi-drug regimen. Conclusion:: “Polypill” therapy in patients with CV diseases, hypertension, dyslipidemia, and high CV risk is associated with more effective blood pressure control compared to monocomponent drugs.

Aim . To determine the potential of using acoustic speech signal analysis parameters and speech biomarkers in the diagnosis and monitoring of cardiovascular diseases. Material and methods . A search was conducted in accordance with the requirements and guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in the PubMed, Google Scholar, ClinicalTrials, CyberLeninka, and eLibrary databases. The review included 14 original studies that analyzed the voice parameters of patients with cardiovascular diseases (heart failure (HF), pulmonary hypertension (PH), and coronary artery disease (CAD)). Static acoustic features and dynamic changes during therapy were examined. Parameters were compared between patients and healthy controls, as well as before and after treatment. Results . Studies examining changes in speech signal parameters in patients with HF have shown that speech indices and acoustic features differ during decompensation compared to discharge. Outpatient studies have noted independent associations with speech rate in patients with HF and/or PH. In studies examining the diagnosis of CAD, voice biomarkers are associated with coronary atherosclerosis based on coronary angiography and with incident coronary events during follow-up. Conclusion . The current systematic review demonstrated that acoustic speech analysis and the resulting voice biomarkers represent available tools for remote monitoring of cardiovascular diseases. However, for implementation into routine practice, multicenter studies and standardization of speech signal analysis methods are necessary. Its validation could form the basis for remote screening and diagnosis, as well as dynamic follow-up monitoring of patients with cardiovascular diseases.

Aim. To analyze the phenotypes of patients at highest risk for albuminuria (AU) in a population of patients without diabetes and to estimate its prevalence in the identified phenotypes. Material and methods. A total of 4580 patients over 40 years of age without type 1 or 2 diabetes, who had not previously been diagnosed with chronic kidney disease, were included in a real-world practice registry of AU detection in patients with previously undiagnosed CKD — AURA. The registry design did not include patient follow-up. AU was determined using sensitive micral-test strips, with an AU cutoff of 20 mg/L. Results. AU ≥20 mg/L was present in 64,9% of cases. According to univariate analysis, patients with AU compared with those without it were more likely to have the following risk factors: hypertension (79% vs 71,5%), male sex (44,2% vs 38,6%), smoking (31% vs 25,2%), metabolic syndrome (32% vs 23,4%), as well as diseases such as coronary artery disease (35,5% vs 29,7%), heart failure (41,5% vs 35%), atrial fibrillation (17,3% vs 12,5%), prediabetes (14,7% vs 8,9%), chronic obstructive pulmonary disease (COPD) (7,67% vs 3,76%), chronic cystitis (5,35% vs 3,49%). A multivariate model revealed that age (with each 1-year increase in age, the risk of AU increased by 2%, p-value Conclusion. A multivariate analysis of AURA registry data confirmed that AU is independently associated with conditions such as post-infarction cardiosclerosis, atrial fibrillation, prediabetes, metabolic syndrome, chronic cystitis, and COPD. Of particular interest is the study and follow-up of patients with COPD, in whom AU was found in 78,9%.

Introduction: The creation of a fixed combination (“polypill”) primarily reflects the medical community's efforts to increase patient adherence to treatment, which contributes to both individual and population- level risk reduction. However, different studies use various methods to assess patient adherence. The results of different studies regarding this topic are controversial. Some studies demonstrate positive effects of “polypill” administration on patient adherence, and other studies show no statistically significant differences compared to standard therapy. The aim of this review was to assess the adherence to treatment in comorbid patients with high cardiovascular risk who used “polypill” therapy compared to standard monocomponent therapy. Methods: The search was conducted in accordance with PRISMA requirements across the databases PubMed, Google Scholar, and ClinicalTrials.gov. Two independent reviewers conducted the search, and in cases of disagreement, a third reviewer was involved. A total of 1.941 publications were analyzed, of which 358 were found in PubMed, 1.580 were found in Google Scholar, and 3 were found in Clinical Trials. A total of 11 publications were selected for the final analysis of full-text articles. The meta-analysis evaluated the adherence to therapy in patients after myocardial infarction, with dyslipidemia, arterial hypertension, and high cardiovascular risk, who used “polypill” therapy, compared to standard therapy with monocomponent drugs. Results: The meta-analysis of adherence to “polypill” therapy compared to standard therapy included 11 studies involving comorbid patients with high cardiovascular risk. The total number of patients was 39.286. 19.664 patients used “polypill” therapy, and 19.622 patients used standard therapy with monocomponent drugs. According to the results of the meta-analysis, high adherence to treatment is more common in patients using “polypill” compared to standard therapy (relative risk (RR) 1.434 (95% CI 1.26-1.64, p< 0.001). Discussion: “Polypill” therapy is generally effective in increasing adherence. Attention should also be paid to other factors that can influence patients’ adherence to “polypill” therapy, such as the duration of the follow-up period, the number of patient visits, initial adherence, and patient education. The advantages and limitations of “polypill” therapy are described in this review. Despite certain limitations, “polypill” is considered a promising option for improving patients’ adherence in clinical practice, especially when combined with other adherence- enhancing strategies. Conclusion: A current systematic review and meta-analysis have shown that the use of fixed-dose combinations (“polypill”) in comorbid patients with high cardiovascular risk is associated with greater adherence to treatment compared to standard therapy with monocomponent drugs.

Objective. To assess speech signal acoustic parameters for the diagnosis of neurological and mental diseases. Material and methods. The data were searched in accordance with the PRISMA requirements and guidelines across the PubMed, Google Scholar, ClinicalTrials.gov, CyberLenink, and eLibrary databases. Seven publications were selected for the final analysis of full-text articles. These papers evaluated the parameters of the speech signal in patients with Parkinson’s disease, Alzheimer’s disease, and primary depression. The meta-analysis examined Jitter and Shimmer in patients’ speech signals compared with those of healthy volunteers. Results. Six studies were included in the meta-analysis in assessing the diagnostic capabilities of changes in fundamental tone frequency (Jitter) for neurological and mental diseases. The meta-analysis included 180 patients and 193 healthy volunteers. According to the results, Jitter was significantly more pronounced in patients with Alzheimer’s disease, depression, and Parkinson’s disease than in healthy volunteers (mean difference 0.786 (0.481—1.091), I2=45.83%, p<0.001). The meta-analysis of speech-signal acoustic analysis results for diagnosing neurological and mental diseases, based on changes in signal amplitude (Shimmer), included 7 studies involving 222 patients and 295 healthy volunteers. There was no statistically significant difference in Shimmer in patients with Alzheimer’s disease, depression, and Parkinson’s disease, compared to patients without diseases (mean difference 0.392 (–0.179—0.962), I2=88.86%, p=0.178). Conclusion. This systematic review and meta-analysis of studies have shown the potential of acoustic analysis of the speech signal for diagnosing neurological and mental diseases. Jitter is a reliable diagnostic criterion for the presence and progression of neurological and mental diseases.

In this article, we discuss the feasibility of combination antiarrhythmic drug therapy in the form of a polypill. In our opinion, this type of treatment is currently limited by various factors discussed in this article. Large-sample studies are needed to evaluate the efficacy and safety of different antiarrhythmic drug combinations in patients with atrial fibrillation, as well as supraventricular and ventricular arrhythmias.

Aim . To develop a prognostic model for the probability of adverse cardiovascular events over three years in patients over 70 years of age with prior myocardial infarction (MI), frailty syndrome, and myocardial revascularization. Material and methods. This prospective study included 92 patients over 70 years of age with MI. Clinical and history data, the Charlson comorbidity index, general laboratory data, myocardial stress and fibrosis biomarkers (NT-proBNP and ST-2), and structural and functional cardiac parameters were assessed. The Age Is Not a Barrier questionnaire was used to identify frailty. The median follow-up period (Q1; Q3) was 1045 (367; 1099) days. An adverse cardiovascular event was chosen as the endpoint. Nonparametric statistical methods, Cox regression, and logistic regression were used. R e sults . The mean age of patients was 77,3±2,4 years. Using Cox regression, following 3-year predictors of adverse cardiovascular events were identified: age ≥80 years (p=0,001), prior MI (p=0,011), CKD-EPI glomerular filtration rate on admission ≤55 ml/min/1,73 m2 (p=0,008), and pulmonary artery systolic pressure ≥38 mm Hg (p=0,022), Simpson’s ejection fraction ≤45% (pConclusion . PCI in patients over 70 years of age with MI and frailty reduces the risk of adverse cardiovascular events over three years. Prediction of adverse cardiovascular events is possible based on the proposed prognostic model.

Background — Chronic heart failure (CHF) is one of the leading causes of mortality. Many factors can influence the risk of mortality in patients with CHF. Therefore, it is necessary to clarify the predictors of mortality in patients with CHF. The goal of our study was to identify predictors of adverse prognosis in patients with CHF. Methods — The study included 591 patients with CHF at 60 medical facilities registered in Samara Region CHF Registry during one month in 2022. Their median age was 71.0 (64.0-80.0) years, and 339 (57.4%) of them were men. The follow-up period lasted 18 months, during which 198 (33.5%) patients died. Results — According to the results of multivariate analysis, prognostic factors associated with mortality in patients with CHF were age (OR 1.024, 95% confidence interval [CI] 1.007-1.042, p=0.006), NYHA functional class IV (OR 2.226, 95% CI 1.358-3.649, p=0.002), pleural effusion (OR 1.423, 95% CI 0.973-2.083, p=0.069), oxygen therapy in outpatient settings (2.401, 95% CI 0.963-5.988, p=0.06), inotropic therapy in a hospital settings (OR 1.559, 95% CI 0.924-2.630, p=0.096), and left ventricular ejection fraction (LVEF) < 40% (OR 1.580, 95% CI 1.066-2.342, p=0.023). Previous cardiac surgery was inversely associated with the probability of death (OR 0.476, 95% CI 0.3-0.755, p=0.002). The area under the ROC curve, corresponding to the relationship between mortality and the value of the logistic regression function, was 0.691 (p=0.023) (95% CI 0.645-0.736). Conclusion — Predictors of mortality in patients with CHF over an 18-month follow-up period include age, NYHA functional class IV CHF, pleural effusion, oxygen therapy in outpatient settings, inotropic therapy in a hospital setting, and LVEF < 40%. Previous cardiovascular surgeries had a favorable effect on mortality in these patients.

Проанализированы данные литературы, посвященные рамановской спектроскопии (РС), представляющей собой современный метод ранней диагностики гематологических заболеваний. Изучены возможности и трудности диагностики с помощью предложенного метода с точки зрения верификации диагноза и оценки эффективности лечения различных онкогематологических нозологий. Результаты проведенных исследований демонстрируют оптимистичную картину использования данного метода в реальной клинической практике и служат основанием для внедрения РС в рутинную практику для более точной и своевременной диагностики гемобластозов и оценки ответа на проведенное лечение. We reviewed literature data on Raman spectroscopy (RS) – modern modality for early diagnosis of hematological diseases. We studied the possibilities and challenges of RS in confirming the diagnosis and evaluating effectiveness of treatment in different hematological malignancies. The results of the studies conducted showed optimistic prospects of implementing this method in clinical practice.RS may promote timely diagnosis of hemoblastosis and assessment of patients’ response to the treatment.