Vol 19, No 4 (2025)

Population aging is a global trend, and by 2050, the proportion of people over 65 years old is expected to be approximately 16 % of the world’s population. In the Kyrgyz Republic, the number of elderly people has increased by 24 % over the past five years, leading to an increase in the prevalence of cardiovascular diseases. Acute coronary syndrome (ACS) remains one of the leading causes of morbidity and mortality in the elderly. Since this category of patients often exhibits atypical clinical manifestations, multimorbidity, and cognitive and functional impairment, this significantly complicates diagnosis and management. This article presents current data on the diagnosis of ACS in elderly patients. Particular attention is paid to the complexity of interpreting complaints and anamnestic data, physical examination, and the specifics of electrocardiogram analysis, where age-related changes and comorbidities often mask ischemic manifestations. The role of high-sensitivity troponin, the standard for diagnosing myocardial injury, is discussed. However, in the elderly, its prognostic value is reduced due to frequent elevations associated with chronic diseases. The capabilities of noninvasive and invasive imaging methods – echocardiography, cardiac magnetic resonance imaging, coronary computed tomography angiography, as well as intracoronary methods such as intravascular ultrasound and optical coherence tomography allowing for a more precise diagnosis and treatment strategy are discussed in detail. It is emphasized that no single imaging method offers sufficient diagnostic accuracy in elderly patients. Therefore, the optimal strategy should be a personalized approach based on a multidisciplinary assessment that takes into account cognitive and functional status, comorbidities, geriatric syndromes, and social factors. This approach improves the timeliness of diagnosis and the effectiveness of medical care, ensuring more favorable outcomes in elderly and senile patients with ACS.

In response to the global increase in chronic noncommunicable diseases, the World Health Organization and the United Nations have adopted strategies to reduce premature mortality. Improving the health literacy of the population which is defined as a combination of knowledge, motivation and practical skills to maintain health is recognized as a key task for achieving these goals. The basic skills for developing health literacy are understanding, explaining, and changing health-related behaviors. The importance of this issue in disease prevention is highlighted by the fact that a number of countries have already established separate national programs to improve health literacy, and in some countries this topic is included in the national strategy for the prevention and control of noncommunicable diseases. There are various models and questionnaires for assessing health literacy, but the lack of a single standardized tool makes this work difficult. At the same time, The Health Literacy Questionnaire (HLQ) and the European Health Literacy Survey Questionnaire (HLS-EU-Q) are considered the most thoughtful due to the assessment of conceptually different areas of health literacy among the subjects. Research shows that the literacy rate is related to socio-demographic factors: it is lower among the elderly, people with low incomes and education levels. It has been demonstrated that patients with a lower level of health literacy are less aware of diseases, do not participate in public life, and have a prognostically unfavorable pattern of behavior, i. e. sedentary lifestyle and poor nutrition. Special attention is paid to the development of digital health literacy, as it moderately correlates with maintaining a healthy lifestyle, as well as medical literacy in matters of immunoprophylaxis.

Aim. To perform functional analysis of the gene-gene interaction networks of miR-143-3p and miR-181b-5p to identify key target genes involved in regulating the coronary atherosclerotic plaque vulnerability and to identify potential therapeutic targets.

Material and methods. The study is based on the analysis of a database of 62 patients with suspected coronary artery atherosclerosis examined by multi-slice computed tomography coronary angiography. The sample included 22 patients with vulnerable plaques, 23 with stable plaques, and 17 without atherosclerosis. Analysis of circulating microRNA levels in blood plasma was performed via real-time reverse transcription polymerase chain reaction using TaqMan kits. Data on experimentally validated target genes were obtained from the TarBase v9.0 database, and data on gene interactions were obtained from the STRING v12.0 database. Interaction networks were built using CytoScape software.

Results. Analysis of the functional connections of miR-143-3p revealed an effect on the key genes HNF4A, SMAD3 and AKT1 involved in the regulation of lipid metabolism, proliferation and differentiation of vascular smooth muscle cells, and angiogenesis. For miR-181b-5p, the main target genes VCAM1, ARRB2, BCL2, and IGF1R were identified, which regulate the processes of monocyte adhesion, inflammation, apoptosis, and vascular stability. Network analysis demonstrated the convergence of PI3K / AKT, TGF-β / SMAD signaling pathways and cell death control mechanisms in regulation of atherosclerotic plaque stability.

Conclusion. Functional analysis revealed the key molecular targets of miR-143-3p and miR-181b-5p involved in pathogenesis of atherosclerosis. The identified microRNAs and their target genes represent promising therapeutic targets for stabilizing atherosclerotic plaques and preventing cardiovascular complications. Evaluation of the expression levels of these microRNAs in combination with imaging techniques can contribute to the development of personalized approaches to diagnosis and treatment of atherosclerosis.

Aim. To demonstrate a multidisciplinary approach in management of a patient with generalized sarcoidosis, heart disease and a life-threatening complication in the form of cerebral infarction which required selection of treatment tactics.

Material and methods. Patient A., 41, presented with sarcoidosis and Löfgren’s syndrome onset at the age of 23 and developed clinically manifested cardiac disease over the next three years. Cardiac sarcoidosis was characterized by complex life-threatening arrhythmias, progression of chronic heart failure, and infarction-like changes in electrocardiograms and echocardiograms necessitating differential diagnosis.

Results. Uncontrolled intermittent use of prednisolone, lack of regular standard therapy for sarcoidosis, and lack of antiarrhythmic therapy largely predetermined the unfavorable course of events, including development of an ischemic stroke at a young age. The development of the cerebral infarction was due to a combination of factors: arrhythmia, newly diagnosed congenital heart defect (patent foramen ovale), hyperhomocysteinemia, and the presence of polymorphisms in the folate cycle genes (MTHFR, MTR).

Conclusion. The diversity of clinical manifestations often leads to diagnostic difficulties and errors. In the absence of adequate therapy, the disease progresses and has an unfavorable prognosis. This article presents a clinical observation of a young patient with generalized sarcoidosis with progressive heart disease, hereditary thrombophilia, patent foramen ovale complicated by the development of a stroke.

The relevance of neurorehabilitation research is determined by the high incidence of acute cerebrovascular pathologies, as well as the increasing risk of disability due to residual impairment after a stroke. Severe motor impairment in the limbs, static and gait disorders, and decreased intellectual and memory functions significantly reduce the quality of life of patients and increase the demand for rehabilitation services. The work considers the fundamental principles of neurorehabilitation: early initiation, comprehensiveness, consistency, interdisciplinary approach, and the appropriate combination of drug and non-drug therapies. The main approaches to motor rehabilitation for patients after a stroke are described in detail, and key areas for stroke recurrence prevention are highlighted. Physical rehabilitation methods include kinesitherapy, occupational therapy, gait training, mechanotherapy, neurodevelopment techniques, and motor control restoration using robotic devices based on biofeedback. Various physiotherapeutic approaches (massage, manual therapy, acupuncture, cryotherapy, magnetic and electrical stimulation technologies) are used as adjunctive methods to enhance the effectiveness of motor rehabilitation. Medicines and rehabilitation methods are presented through the prism of evidence-based medicine. Particular importance is given to the correction of cognitive disorders, since their preservation directly affects the success of recovery. Cognitive rehabilitation includes the use of external compensatory strategies, metacognitive training, environmental adaptation with scanning training and multisensory stimulation methods, speech exercises, as well as various computer programs and paper-based methods with training in concentration, rapid selection and switching of attention. The mechanism of action and proven efficacy of choline alfoscerate (Cereton), a multifunctional drug, are demonstrated; its use as part of a comprehensive rehabilitation program significantly improves patients’ cognitive state and enhances their adaptive capacity.