The aim: To assess the efficacy and safety of dapagliflozin in the treatment of comorbid cardiac patients with type 2 diabetes mellitus (T2DM) in combination with arterial hypertension (AH) and overweight in outpatient setting. Materials and methods: Under observation were 19 patients who were treated in outpatient setting during 2019-2021 for AH and had T2DM, overweight or obesity. As part of complex treatment, patients received dapagliflozin 10 mg once a day for 12 months. Results: The normalization of blood pressure, elimination of heart failure symptoms on the background of increased ejection fraction, improved indicators of the functional capacity of the kidneys, and a decrease in the degree of proteinuria/albuminuria were noted after treatment. The patients had an easier time losing weight (body mass index and waist circumference decreased; p<0.05) and decreased levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). None of the monitored patients had cases of hypoglycemia or urinary tract infection. The number and/or doses of antihypertensive, hypouricemic and diuretic drugs were gradually reduced. Conclusions: Using dapagliflozin in a standard dose of 10 mg/day in the complex therapy of patients with T2DM in combination with arterial hypertension and overweight contributes not only to the normalization of blood pressure, but also to a reduction in body weight and waist circumference. The proposed therapy can be an alternative for the treatment of patients with T2DM with concomitant overweight or obesity, arterial hypertension, with or without heart and/or renal failure as a first-line antidiabetic drug.

The aim: To investigate the features of coagulation homeostasis in patients with liver cirrhosis (LC) in COVID-19 infection. Materials and methods: At the clinical base of the Department of Propaedeutics of Internal Medicine, 32 patients with LC infected with COVID-19 were examined – 1 Group of patients. The study also included 30 patients with LC who were not infected with COVID-19 (2 Group of patients). Results: The analysis of the obtained data indicates disorders of the hemostasis system in patients with LC without the COVID-19 infection (Group 2), as well as in patients with LC at the time of being infected with COVID-19. The violation of the protein synthesis function of the liver is manifested through a decrease in the level of fibrinogen in blood serum (up to 2.0±0.5 gr/l in patients of Group 1 at the time of admission for inpatient care) and up to 21.9±0.5 gr/l in patients of group ІІ – р<0.05. This was accompanied by an acceleration of prothrombin time, thrombin time and activated partial thromboplastic time in patients with LC, as well as an increase in the level of antithrombin III. The level of D-dimer was reduced both in patients of group II and in patients of group I at the time of being infected with COVID-19 Conclusions: Changes in coagulation homeostasis characteristic of hypocoagulation syndrome have been established in patients with LC. COVID-19 infection in patients with LC leads to hypercoagulation, especially in patients with complicated stage of LC (ascites, encephalopathy, hepatorenal syndrome).

Aim: To investigate the peculiarities of clinical and laboratory changes in liver cirrhosis in TORCH-infected patients and their dynamics against the background of complex therapy with the use of Polyana Kvasova mineral water (MW). Materials and Methods: 64 patients with alcohol-related LC were examined. The study was carried out in two stages. At the 1st stage, the examined patients with LC were divided into two groups depending on the presence or absence of TORCH infections to determine the characteristics of the clinical course of LC in these patients. Group I included patients with LC (n=30), who were not diagnosed with TORCH infection, and group II included patients with LC who tested positive for antibodies to infections of the TORCH group (n=34). The data of patients of group II were divided into two subgroups, depending on the treatment performed. Patients of subgroup IIA (n=16) received only basic therapy (BT), and patients of subgroup IIB (n=18) were additionally prescribed 100 ml of warm, still carbonated bicarbonate-sodium Polyana Kvasova mineral water (MW), 15-20 minutes before meals 6 times a day. The duration of the treatment and observation of patients at the second stage of the study was 1 month. Results: In patients with LC of group II, signs of jaundice, pain and dyspeptic syndromes were statistically significantly more often detected - p<0.05. In group II of patients with LC, a more pronounced, statistically significant increase in the indicators of cholestatic syndrome. A more significant reduction in the manifestations of dyspeptic and pain syndrome, as well as the severity of jaundice, was observed in LC patients of the IIB subgroup who, in addition to BT, were prescribed Polyana Kvasova MW. A significant decrease in laboratory markers of cholestatic syndrome was established (TBIL level by 20.0±0.6 mmol/L; ALP by 84.0±1.8 IU/L, GGT by 48.7±1.5 U/L) in the subgroup of patients, who in addition to BT were prescribed MW. Conclusions: 1. In TORCH-infected patients, alcohol-related liver cirrhosis is more often detected at the stage of subcompensation (class C according to Child-Pugh) and is clinically detected by signs of dyspeptic and pain syndromes, as well as laboratory manifestations of cholestatic syndrome and jaundice syndrome. 2. The use of Polyana Kvasova MW as part of the complex therapy of patients with alcohol-related liver cirrhosis in combination with TORCH infection is a pathogenetically based and safe method for reducing the severity of dyspeptic and pain syndromes, as well as clinical and laboratory signs of jaundice in these patients.