Aim. To study the characteristics of nutrition and  lifestyle of young men depending on the distribution of adipose tissue, as well as their relationship with data from various scales for assessing absolute and relative cardiovascular risk (CVR).

Design. A cross-sectional comparative study.

Materials and methods. The study included 150 men aged 20–45 years, average age 36 [32; 41] years. Participants were recruited into three groups of 50 people each based on data of anthropometry and bioimpedance analysis (BIA) of body composition: group 1 — without abdominal obesity (AO), group 2 — with AO and predominantly subcutaneous type of fat tissue distribution, group 3 — with AO and predominantly visceral type of fat tissue distribution. Anthropometric analysis, caliperometry, BIA, and ultrasound were used to assess the proportion of fat tissue and the nature of its distribution. Behavioral risk factors were assessed using questionnaires. The SCORE2, Framingham 2008, Predicting Risk of cardiovascular disease EVENTs (PREVENT), QRISK3, Framingham-30, and Mayo Clinic Heart Disease Risk Calculator scores were used to assess absolute and relative CVR.

Results. In young men aged 20–45 years with and without AO, smoking status was comparable; the overall  level of physical activity (PA) according to the Global Physical Activity Questionnaire was also comparable across the three groups (p = 0.923) — about 70% of patients had a moderate level of PA and 30% had a low level. Men with AO and a predominantly visceral type of fat tissue distribution (group 3) mainly consumed alcohol 1–2 times a week, which was twice as often as in the group of men without AO (group 1) (48 and 22%, respectively, p_1–3 = 0.019). Additionally, the number of alcohol servings per occasion was higher in Group 3 (p_1–3 < 0.001). When assessing food categories using the Food Frequency Questionnaire, differences between the groups were found only in the consumption of processed meat products: men in group 2 consumed them 2–4 times a week in 40% of cases, which is 5 times more often than in group 1 (p_1–2 = 0.001); in group 3, 4% of men consumed processed meat products almost daily (p_1–3 = 0.014). Correlation analysis revealed significant relationships between dietary habits, PA levels, and indicators reflecting body fat composition. Some dietary features that are not included in the risk stratifiers in the studied scores also demonstrated positive correlations with the CVR assessment. In particular, positive correlations were observed between the frequency of alcohol consumption (r_s = 0.189–0.328, p < 0.001–0.037), the number of alcohol servings per occasion (r_s = 0.169–0.203, p = 0.013–0.038) and the values of all studied  risk scores except SCORE-2. Negative correlations were found between the “Leisure-time PA” indicator and the scores reflecting relative risk: QRISK3 (r_s = –0.182, p = 0.03) and Framingham-30 based on body mass index (r_s = –0.172, p = 0.035); and between the “PA at work” indicator and the values of Framingham-30 lipid-based score (r_s = –0.168, p = 0.039).

Conclusion. From the perspective of behavioral factors, the group at risk for cardiovascular diseases includes not only men with diagnosed AO but also young men without AO, as they share comparable smoking status, dietary patterns, and level of PA. The absence of AO in men can create a false impression of metabolic well-being and can diminish motivation for lifestyle modification. Screening for behavioral risks in young men, especially those with a predominantly visceral fat tissue distribution, should extend beyond the assessment of anthropometric indicators and must account for the frequency and quantity of alcohol consumption, the frequency of consuming ultra-processed foods, red meat, and bread, as well as the level of PA.

Aim. To study the effect of extended-release (XR) metformin after 12 months of use on humoral cardiometabolic markers, parameters of lipid peroxidation (LPO) and vascular stiffness in patients with chronic heart failure with preserved ejection fraction (CHpEF), prediabetes and abdominal obesity (AO).

Design. A single-center, open-label, randomized, controlled clinical trial.

Materials and methods. The PredMet study included 64 patients (50% men) with CHpEF, prediabetes, and AO. The patients were divided into two groups: group A — metformin XR at a dose of 1000–1500 mg per day for 12 months on the background of standard CHpEF therapy; group B — standard CHpEF therapy. Humoral cardiometabolic parameters (levels of the soluble form of interleukin 33 receptor (soluble ST2), N-terminal propeptide of natriuretic hormone (NT-proBNP), highly sensitive C-reactive protein, hs CRP), oxidative stress parameters (baseline level of malondialdehyde (MDA) in low-density lipoproteins (LDL) and their resistance to oxidation) and the radial augmentation index.

Results. After 12 months of the main follow-up period in group A, the level of NT-proBNP decreased by 1.5% (p = 0.007), and the serum hs CRP decreased by 20.7% (p = 0.021) from the baseline values. The concentration of MDA, estimated directly in LDL, when taking metformin XR against the background of standard CHpEF therapy decreased by 4% (p = 0.018), and the content of MDA in LDL after incubation with copper ions decreased by 0.3% (p = 0.035). In group B, on the contrary, there was an increase in the basal level of MDA in LDL by 0.7% (p = 0.044) and its value after incubation of LDL with copper ions by 6.1% (p = 0.009). The levels of soluble ST2 and the radial augmentation index did not differ at visits 1 and 3 in both groups.

Conclusion. Taking metformin XR for 12 months at a dose of 1000–1500 mg per day in addition to standard CHpEF therapy in patients with prediabetes and AO is associated with a decrease in markers of inflammation and LPO, as well as a decrease in the level of NT-proBNP. 

Aim. To analyze the association of the rs3730089 nucleotide sequence variant of the PIK3R1 gene with various metabolic disorders in patients with type 1 diabetes mellitus (T1DM).

Design. A one-stage cross-sectional study.

Materials and methods. 147 unrelated patients with T1DM were examined. Their height, body weight, waist and hip circumferences, and body mass index were measured. Laboratory tests included the determination of total cholesterol, high- and low-density lipoprotein cholesterol, and triglycerides. The variant of the nucleotide sequence was investigated using a polymerase chain reaction. Using the χ² criterion, the correspondence of the frequency of genotypes to the Hardy — Weinberg equilibrium was estimated. The association of genotypes with insulin resistance was analyzed using the online SNPStats program. Association analysis is presented in codominant, dominant, recessive, overdominant, and additive models, as well as during the allele test.

Results. The distribution of genotypes and alleles of the rs3730089 nucleotide sequence variant of the PIK3R1 gene in all patients corresponded to the Hardy — Weinberg equilibrium. There was a significant association of A/C and A/A genotypes in dominant models with elevated levels of low-density lipoproteins and cholesterol. In the overdominant model, the association of the A/C genotype with elevated triglyceride levels, as well as with increased waist circumference and overweight in patients with Т1DM was determined (odds ratio — 10.5, 95% confidence interval: 3.94–27.99, p < 0.0001, р^FDR = 0.0001 and odds ratio — 5.70, 95% confidence interval: 2.28–14.26, p = 0.0001, р^FDR = 0.0002, respectively). For all of the above indicators, allele A was risky. Associations of genotypes and alleles of the rs3730089 nucleotide sequence variant of the PIK3R1 gene with a reduced level of high-density lipoproteins have not been found.

Conclusion. The nucleotide sequence rs3730089 of the PIK3R1 gene is associated with lipid metabolism disorders in patients with Т1DM.

Allele A is risky. This variant of the nucleotide sequence may be associated with insulin resistance in people with T1DM. 

Aim. To evaluate the relationship between alcohol consumption (taking into account the amount of alcoholic beverages consumed) and the content of unsaturated fatty acids in the blood of men in Novosibirsk.

Design. Single-center observational single-stage study.

Materials and methods. The work was performed as part of a single-stage epidemiological study “Epidemiology of cardiovascular diseases and their risk factors in the districts of the Novosibirsk region” (ESSE-RF3) in 2020–2022. The study included 600 men with an average age of 56.4 ± 11.5 years. All participants had blood taken from the ulnar vein on an empty stomach after 12 hours of fasting for biochemical studies. The following fats were determined by high-performance liquid chromatography in blood plasma: alpha-linolenic acid (From 18:3, omega-3), eicosapentaenoic acid (From 20:5, omega-3), docosahexaenoic acid (From 22:6, omega-3), linoleic acid (From 18:2, omega-6), gamma-linolenic acid (From 18:3, omega-6), digomo-gamma-linolenic acid (From 20:3, omega-6), arachidonic acid (From 20:4, omega-6), docosatetraenoic acid (From 22:4, omega-6), docosapentaenoic acid (From 22:5, omega-6), hexadecene (From 16:1, omega-9), oleic acid (From analyzed. According to the level of alcohol consumption per week, the study participants were divided into three groups: group 1 (low alcohol consumption) < 8 doses; group 2 (moderate alcohol consumption) ≥ 8 doses < 16; group 3 (high alcohol consumption) ≥ 16 doses.

Results. It was found that in the group of men with moderate consumption of alcoholic beverages, the level of docosatetraenoic acid is higher than in the group of men with low alcohol consumption. Linear regression analysis revealed a significant independent association (B = 0.063; p = 0.009) between alcohol intake and blood levels of docosatetraenoic acid.

Conclusion. A significant direct independent association was obtained between the consumed dose of alcohol and the level of docosatetraenoic acid in the blood. The results confirm the known data on direct associations of docosatetraenoic acid with the risk of cardiovascular diseases and their complications. Keywords: fatty acids, docosatetraenoic acid, alcohol.

Aim. To study the association of rs9939609 of the FTO gene with various obesity phenotypes, its individual parameters, and some risk factors in a sample of women

Design. Cross-sectional cohort study.

Materials and methods. The study was conducted on the basis of the population sample of the HAPIEE project, the age of the participants was — 45–69 years (n = 1036). Groups of women were formed, selected by body mass index (BMI) using the criteria of the World Health Organization. DNA was isolated from blood using the phenol-chloroform extraction method. Genotyping of the rs9939609 gene FTO was performed using polymerase chain reaction (PCR) with restriction fragment length polymorphism and real-time PCR (TaqMan probes). The frequency of genotypes in groups with different BMI, with different body roundness indexes (BRI), waist and hip circumference; with morbid obesity (MO) and abdominal obesity (AO) was analyzed.

Results. When comparing the frequencies of the A allele (AA and AT genotypes) and the TT genotype in groups with different BMIs, significant differences were obtained (p = 0.007). The highest frequency of the TT genotype (38.5%) was in the group of women with a BMI of 18.5 to 24.9 kg/m², the  lowest (23.5%) — with a BMI of 35 to 39.9 kg/m². In this group, the AA genotype was most common. The frequency of carriage of the AT genotype increased nonlinearly with increasing BMI. The statistical significance of differences in BMI between carriers of different genotypes according to the Kruskal — Wallis — test is less than 0.001. Significant differences were also observed in waist (p = 0.001) and hip (p < 0.001) circumferences — the smallest in carriers of the TT genotype. In univariate logistic regression analysis with age-adjusted adjustment, the odds ratio (OR) of having MO in the AA genotype — 1.80 (95% confidence interval (CI): 1.09–2.95; p = 0.021), in the AT genotype — 1.82 (95% CI: 1.23–2.68; p = 0.002), and in the TT genotype — 0.56 (95% CI: 0.39–0.81; p = 0.002). In the univariate logistic regression analysis with age-adjusted analysis, the significance of the TT genotype carriage as a conditionally protective factor in relation to the development of MO (OR = 0.56; 95% CI: 0.34–0.91; p = 0.021) and AO (OR = 0.65; 95% CI: 0.45–0.94; p = 0.023) was preserved, as was the increased probability of AO in carriers of the AT genotype (OR = 1.53; 95% CI: 1.15–2.02; p = 0.003) and AA genotype (OR = 1.54; 95% CI: 1.06–2.23; p = 0.023).

Conclusion. Carriage of the A allele of rs9939609 of the FTO gene is an important factor associated with various obesity phenotypes in women. Due to the diversity of factors associated with obesity, it is necessary to continue research in this area to develop effective personalized preventive and therapeutic strategies.

Aim. To analyze the effect of intermittent hypoxic-hyperoxic training (IHHT) on nutritional status indicators in individuals with morbid obesity.

Design. Prospective, single-center, non-randomized study.

Materials and methods. The study included 40 patients with morbid obesity, who were divided into two groups: Group 1 (control) — 20 individuals (10 men and 10 women) adhering to a high-protein diet (HPD) variant and general recommendations for optimal physical activity; Group 2 (main) — 20 individuals (10 men and 10 women) who were prescribed HPD in combination with IHHT. All patients underwent an assessment of clinical status, body composition analysis (bioimpedance analysis), and determination of biochemical markers of protein, lipid, and carbohydrate metabolism in blood plasma.

Results. IHHT was associated with a significant decrease in low-density lipoprotein levels and a more pronounced reduction in glucose levels (5.25 and 5.63 mmol/L, respectively; p = 0.021), a smaller decrease in the percentage of body fat (45.6 and 53.5%, respectively; p = 0.012), and an increase in basal metabolic rate (2314 and 1804, respectively; p = 0.001) compared to patients prescribed HPD alone. In addition, the control group showed a significant increase in uric acid, erythrocyte, and hemoglobin levels (p < 0.05), which was not observed in the main group (p > 0.05).

Conclusions. The addition of IGHT to HPD in the course of therapy of patients with morbid obesity is safe and promotes a more pronounced improvement of blood biochemical parameters, bioimpedanceometry indices and increase in basal metabolism, compared to isolated HPD.

Aim. To assess the prevalence of metabolic syndrome (MS) in patients with psoriatic arthritis (PsA) and to determine the associations of serum angiopoietin-like proteins (Angptl) of different types with the characteristics of metabolic disorders in this disease.

Design. Single-center cross-sectional clinical study.

Materials and methods. Forty-five patients older than 18 years with PsA (25 women and 20 men; mean age 47.5 ± 12.2 years; disease duration 7.9 ± 6.2 years) with predominantly high (DAS (Disease Activity Score) > 3.7) disease activity (67%) were examined. The presence of psoriasis was confirmed in 100% of cases, obesity of various severity was diagnosed in 17 people. Standard clinical and laboratory examination of all participants was supplemented by determination of serum Angptl of types 3, 4 and 6 by enzyme-linked immunosorbent assay.

Results. One-factor analysis of variance revealed no association between PsA activity and Angptl levels. MS according to the criteria of the International Diabetes Federation (IDF, 2006) was diagnosed in 27 (60%) patients with PsA. Intergroup comparison of Angptl indices of different types demonstrated an increased level of Angptl type 6 in the presence of MS (p = 0.018). Arterial hypertension was associated with high levels of type 6 Angptl in patients with PsA in the presence of MS. The content of Angptl types 3 and 6 was significantly higher in obese patients than in overweight patients (p = 0.002) and in PsA patients without obesity (p = 0.024).

Conclusion. Concentrations of serum Angptl types 3, 4 and 6 vary according to different metabolic phenotypes of PsA. Angptl types 3 and 6 can be used as diagnostic markers of metabolic disorders in PsA patients.

Aim. To assess the frequency and risk factors of carbohydrate metabolism disorders in the post-COVID period.

Design. The retrospective study.

Materials and methods. The study using the continuous sampling method included 1969 patients hospitalized in the hospital of the Bashkir State Medical University Clinic with a confirmed diagnosis of COVID-19 in the period from April 16, 2020 to January 1, 2021. Based on the clinical, anamnestic and laboratory data of the patients, two study groups were formed. The first group included 980 people without carbohydrate metabolism disorders — 402 (41.02%) men and 578 (58.98%) women, whose median age was 54 [43; 63] years. The second group included 989 patients with newly diagnosed hyperglycemia (NDH) during inpatient treatment in the acute phase of COVID-19 — 463 (46.8%) men and 526 (53.2%) women aged 59 [49; 67] years. After discharge from the hospital, these patients were analyzed for cases of diagnosis of type 2 diabetes mellitus, impaired glucose tolerance, and impaired fasting glycemia. Prognostic models for the development of carbohydrate metabolism disorders in the post-COVID period were built.

Results. The observation period in the post-COVID period was 3.5 years, disorders of carbohydrate metabolism were established in 108 (5.5%) cases, including newly diagnosed T2DM in 61 (3.1%) patients and prediabetes in 47 (2.4%) people. In patients with New-Onset hyperglycemia in the acute phase of COVID-19, the prevalence of disorders of carbohydrate metabolism in the remote post-COVID period was 3 times higher than in individuals with normoglycemia, including T2DM (4.95 and 1.22%, respectively, p < 0.0001) and prediabetes (3.24 and 1.53%, respectively, p < 0.0001). In order to identify risk factors for the development of disorders of carbohydrate metabolism in the post-COVID period the initial clinical, anamnestic and laboratory-instrumental characteristics of patients were studied. The reliable parameters obtained during the comparison using the Mann-Whitney method and subsequent univariate logistic analysis were included in the regression model of multivariate analysis, where the following indicators were defined as independent predictors of carbohydrate metabolism disorders: age, venous plasma glucose level upon hospitalization, and history of arterial hypertension. As a result of the analysis, predictors of the development of carbohydrate metabolism disorders were established separately for patients with normoglycemia and newly diagnosed hyperglycemia in the acute period of COVID-19. It has been established that in patients with normoglycemia, risk factors for the development of disorders of carbohydrate metabolism in the post-COVID period are age over 62 years, erythrocyte sedimentation rate above 35 mm/h, Charlson comorbidity index greater than 1 point and C-reactive protein level greater than 30 mg/l. In individuals with newly diagnosed hyperglycemia, independent predictors were fasting venous plasma glucose level over 8.6 mmol/l upon hospitalization and body mass index (BMI) over 29.2 kg/m². A model with maximum predictive ability was constructed, including both predictors, its sensitivity was 43.04%, specificity — 79.37%.

Conclusion. New-onset hyperglycemia in the acute phase of COVID-19 can be considered as a kind of indicator of high risk of developing T2DM and prediabetes in the post-COVID period. Risk factors for carbohydrate metabolism disorders in the late post-COVID period in patients with new onset hyperglycemia in the acute phase of COVID-19 are hyperglycemia > 8.6 mmol/L and BMI > 29.22 kg/m2 upon hospitalization. The study of the long-term effects of the new coronavirus infection and the search for prognostic markers are urgent healthcare tasks, the solution of which will minimize post-COVID complications and disability of patients.

Aim. To characterize the quality of life of patients with post-COVID syndrome depending on the presence of newly identified carbohydrate metabolism disorders (CMD) in the post-COVID period.

Design. Cross-sectional study.

Materials and methods. A total of 132 people with post-COVID syndrome were examined. The patients were divided into two groups: group 1 included 72 people with newly diagnosed impaired glucose tolerance (IGT) (n = 36) and type 2 diabetes mellitus (DM) (n = 36) in the post-COVID period, and group 2 included 60 people without concomitant CMD. The groups were comparable in terms of age and gender.

The average age of patients in group 1 was 61.0 [53.3; 66.5] years (with IGT — 58.5 [54.2; 62.5] years, with DM — 63.5 [51.0; 68.3] years), there were 26 men (36.1%), 46 women (63.9%); the average age of group 2 was 56.5 [51.0; 66.0] years, men — 24 (40.0%), women — 36 (60.0%). The duration of the course of post-COVID syndrome at the time of inclusion in the study in patients with IGT was 6.0 [4.8; 6.0] months, with type 2 diabetes — 6.0 [5.0; 6.0] months.

The presence of post-COVID syndrome was established on the basis of signs and symptoms that developed during and / or after COVID-19 infection, lasted more than 12 weeks and were not explained by an alternative diagnosis. The diagnosis of CMD (type 2 diabetes and IGT) was established in accordance with the Algorithms for specialized medical care for patients with diabetes mellitus (2021). The quality of life of patients was determined by conducting a questionnaire using the SF-36 questionnaire, containing 8 assessment scales: physical functioning, role physical functioning, vital activity, general health, mental health, social functioning, role emotional functioning, pain intensity, which form two parameters — psychological and physical components of health. The indicators of each scale vary from 0 to 100 points, and a higher result corresponds to a better quality of life of the subject. Patients filled out the questionnaire themselves, the analysis of the results was carried out using a specially developed computer program.

Results. The study groups were characterized by polymorbidity, in the 1st group, dyslipidemia (61.1%) and diseases of the urinary system (33.3%) were significantly more common. Patients with CMD had statistically significantly lower quality of life indicators according to the physical and role functioning scales, amounting to 55.00 and 25.00%, respectively. IGT and type 2 diabetes mellitus, first identified in individuals with post-COVID syndrome, had the most significant impact on the assessment of the physical component of health (33.29%), the indicator of the psychological component of health (52.36%) was comparable to that in the group without CMD (54.12%).

Conclusion. The combination of post-COVID syndrome and CMD significantly reduces a number of quality of life indicators in this category of patients. One of the significant predictors of deterioration in quality of life in individuals with post-COVID syndrome according to the physical and role functioning scales is CMD identified for the first time in the post-COVID period.

Aim. Based on the analysis of data from modern scientific literature, to demonstrate the influence of the circadian system on the function of adipose tissue and on the formation of metabolically unhealthy obesity.

Key points. The circadian system regulates metabolic processes through complex neuroendocrine pathways, affecting key cellular structures. The central and peripheral circadian rhythms adapt the functions of organs and systems to sleep/wake and nutrition/starvation cycles, making a significant contribution to maintaining the body's metabolism in a state of equilibrium. At the level of adipose tissue, the circadian system regulates lipogenesis and lipolysis, and is also involved in the secretion of adipocytokines. Circadian regulation of the activity of lipogenesis and lipolysis is carried out mainly due to the influence on the processes of gene transcription of a number of key enzymes of adipose tissue involved in both processes. Disruption of the circadian rhythm leads to metabolic, hormonal, and energy imbalances. As a result of circadian rhythm disorders, the endocrine function of adipose tissue, lipid composition and variability of blood glucose levels, as well as insulin sensitivity, change, which can lead to the development of metabolically unhealthy obesity.

Conclusion. The circadian system is the coordinator of human behavioral and physiological functions depending on the time of day. Peripheral circadian oscillators, obeying the central circadian clock, regulate metabolic processes at the level of adipose tissue, liver, kidneys, muscles, etc. The coordinated operation of this entire system ensures energy homeostasis. Circadian rhythm disorders can contribute to the development of obesity, diabetes mellitus, and diseases of the cardiovascular system and cause metabolically unhealthy obesity, while a healthy lifestyle, optimizing work schedules, and eliminating sleep disorders improve metabolic processes.

Aim. Using a clinical example, to demonstrate the possibility of developing spontaneous coronary artery dissection with the formation of myocardial infarction in a young obese woman.

Key points. Obesity is one of the leading factors in the development of metabolic syndrome and related cardiovascular diseases. There is evidence of a relationship between metabolic disorders and the development of myocardial infarction in young women. Spontaneous coronary artery dissection as a cause of myocardial infarction in young women with metabolic disorders is discussed in the scientific literature. However, there is insufficient information on this issue. The presented clinical case discusses a possible relationship between extreme obesity and the development of spontaneous coronary artery dissection, which caused myocardial infarction in a 35-year-old obese woman who underwent bariatric surgery for this reason. The clinical picture was typical of the anginal variant of the initial period of myocardial infarction. Narcotic analgesics were required to relieve the pain syndrome. During emergency coronary angiography, spontaneous dissection of the left coronary artery trunk — intermediate third of the anterior interventricular branch type B-C according to Ellis with signs 

Aim. To demonstrate the features of diagnosis and treatment of sleep disorders in a patient with obesity and type 2 diabetes mellitus (T2DM), as well as to discuss the optimal strategies for comprehensive management of such patients in clinical practice.

Key points. Sleep disorders are an urgent problem in the context of obesity and T2DM due to the high prevalence of these comorbid conditions, their interrelated pathogenesis, their impact on cardiometabolic risks, and the difficulties in diagnosis and treatment. In this clinical case, modern methods were used to diagnose and treat sleep disorders in a patient with T2DM, including questionnaires, somnography (using the WatchPAT system), cognitive-behavioral therapy for insomnia, CPAP therapy, and laboratory and instrumental methods for diagnosing and treating T2DM. The use of a comprehensive approach significantly improved the patient's metabolic parameters, with a 26-kg weight loss and a decrease in glycated hemoglobin levels to 5.5%. The patient's sleep patterns also improved: decrease in the apnea/hypopnea index from 39.8 to 1 episode per hour against the background of CPAP therapy and up to 1.7 episodes per hour without ventilatory support, as well as a decrease in the severity of daytime drowsiness on the Epworth scale from 19 to 5 points (within the normal range).

Conclusion. On the example of the presented clinical case, the algorithm of management of patients with morbid obesity, T2DM, obstructive sleep apnea and insomnia is presented, which has practical significance for doctors. Analyzing this observation will help professionals make more informed decisions regarding the diagnosis, treatment, and monitoring of these comorbid diseases, which will improve the health and quality of life for patients.

Aim. To demonstrate a case of severe hepatic encephalopathy with focal neurological symptoms in the early postoperative period after transjugular intrahepatic portosystemic shunting (TIPS).

Key points. TIPS is the most common and effective pathogenetically justified shunting method for correcting portal hypertension in liver cirrhosis. The modern transplantology doctrine dictates an increasing need for TIPS as a bridge technology that improves patient survival on the liver transplant waiting list. The progression of hepatic encephalopathy in the postoperative period following this intervention is the main expected adverse consequence of the procedure. Timely diagnosis of worsening neuropsychiatric function in patients who have undergone TIPS and its effective restoration are pressing issues in contemporary gastroenterological practice. Screening examinations to detect hepatic encephalopathy should be regularly performed for all patients, who have undergone TIPS, regardless of the timing of the procedure. Complex therapy, including ornithine, lactulose, and antibacterial drugs to suppress excessive bacterial growth in the intestine, should be prescribed from the first days after the intervention. Since suppressing excessive bacterial growth in the intestine in patients with hepatic encephalopathy is an independent pathogenetically based therapeutic target, cyclical use of antibacterial agents for intestinal sanitation in patients with TIPS significantly enhances the effectiveness of controlling hepatic encephalopathy.

Conclusion. This case clearly demonstrates that the foundation of successful treatment for a patient with liver cirrhosis lies in the continuity and interconnection of all stages of care provision.