I.P. Pavlov Russian Medical Biological Herald

INTRODUCTION: Endocrine ophthalmopathy (EO) is a multifactorial autoimmune disease, with the need of further study of immunological and biochemical pathogenetic factors of this disease.

AIM: To assess the levels of thiobarbituric acid reactive substances (TBARS), total antioxidant activity, and the BB isoform of platelet–derived growth factor (PDGF-BB) in patients with EO in the course of glucocorticoid pulse therapy.

MATERIALS AND METHODS: A total of 30 individuals were examined, from which 2 groups were formed: a control group (n = 15) and a clinical group of patients with an active phase of EO before and after glucocorticoid pulse therapy (n = 15). A comparative clinical and laboratory analysis was conducted that included a comprehensive ophthalmological examination, determination of TBARS level, of the total antioxidant activity and PDGF-BB in blood serum.

RESULTS: TBARS concentration in the EO group before glucocorticoid pulse therapy exceeded values of the control group (р < 0.001) and did not differ from the parameters after treatment (р = 0.683). The total antioxidant activity before treatment was reduced compared to the control (р < 0.001) and also had no significant differences with the parameters after treatment (р = 0.345). The level of PDGF-BB in the active phase of EO before pulse therapy 2.3 times exceeded that of the control group (р < 0.001), 1.5 times decreased with pulse therapy (р < 0.001), but remained 1.6 times (р = 0.008) the control. Statistically significant relationships were found between the content of PDGF-BB and parameters of ‘peroxidation — antioxidant defense’ system (p < 0.001).

CONCLUSION: In patients with EO in the active phase, an imbalance in the ‘peroxidation — antioxidant defense’ system was found in terms of increased production of TBARS. In the course of glucocorticoid pulse therapy, the identified imbalance persisted. In the active phase of the disease, a significant increase in the level of PDGF-BB was detected, with the concentration remaining elevated after treatment. Correlations were established between the parameters of oxidative stress and the level of PDGF-BB. In view of the obtained data, it seems necessary to develop and introduce the alternative treatment methods for EO targeted at trigger points in the pathogenesis of this disease.

INTRODUCTION: The combination of cholelithiasis and liver fatty degeneration (LFD) is becoming increasingly common. The postcholecystectomy complications significantly reduce the quality of life of patients who have undergone surgery. Complications of LFD stimulate a search for new prognostic markers and algorithms for timely initiation of effective treatment.

AIM: To identify prognostic criteria for complications of the course of LFD in the long-term period after cholecystectomy (CE) in patients of different age, and scientifically substantiate their significance for the earliest verification facilitating timely and effective treatment.

MATERIALS AND METHODS: To identify prognostic criteria for complication of the LFD course in the long-term period after laparoscopic CE, 301 patients (153 men and 149 women) were examined. Anthropometric data, hemodynamic parameters were assessed, autonomic regulation index was calculated. Ultrasound assessment of choledoch and liver elastography, magnetic resonance imaging of the liver and magnetic resonance cholangiopancreatography were performed. Laboratory parameters were analyzed. Using chromatography-mass-spectrometry, microbial markers of the parietal microbiome of the intestine were determined.

RESULTS: Complication of the course of LFD was associated with predomination of sympathetic regulation of the autonomic status in individuals under 60. At an older age, these influences were less pronounced. One year after CE, patients displayed an increase in body weight, more pronounced in the group < 60 years. This was associated with an increase in the choledoch diameter after CE, mostly in patients aged 45–59, being a sign of Oddi’s sphincter dyskinesia. A relationship was found between complication of the course of LFD and disorders of the structure of the intestinal microbial association caused by a decrease in the obligate microflora and increase in the opportunistic microflora, mostly due to the aerobic microflora; these changes were most evident in patients ≥ 60 years.

CONCLUSIONS: The complication of the course of LFD in the late period after CE is significantly affected by age, autonomic regulation, body weight and the structure of the resident intestinal microbial association. In the older group, autonomic regulation has a smaller effect, and an increase in body weight and a change in the structure of the intestinal parietal microbiome are greater than in younger individuals.

INTRODUCTION: Pneumonia is one of the most common inflammatory diseases of the lower airways associated with a high risk of development of life-threatening complications, the effective correction of which requires taking into account the peculiarities of inflammatory response of an organism, in particular, determination of cytokine production.

AIM: To study the peculiarities of cytokine and inflammatory effector molecule production in patients with community-acquired pneumonia (CAP) with the underlying acute respiratory viral co-infection.

MATERIALS AND METHODS: A total of 85 patients of both genders aged 18 to 33 years with bacterial CAP were examined, including 30 patients without signs of acute respiratory viral infection (ARVI), 55 patients with ARVI in the first 3 days of illness, and 25 practically healthy individuals. In the venous blood serum, the concentration of interleukins (IL) IL-1β, -2, -4, -8, -10, -11, -12, -13, -15, -18, -17A, -20, -23, -24, -28A, -33, interleukin-1 receptor antagonist, tumor necrosis factor α (TNFα), interferons (IFN): IFNα and IFNγ, macrophage inflammatory protein 3α (MIP3α), monocyte chemoattractant protein 1, granulocyte colony-stimulating growth factor, transforming growth factor β, basic fibroblast growth factor (bFGF), vascular endothelial growth factor A, soluble form of type 1 receptor to VEGF-A, soluble form type 1 receptor to TNFα, were determined.

RESULTS: In patients with mild CAP with added ARVI, the greatest increase was noted in production of IL-17A compared to patients without ARVI (р = 0.043). At the same time, production of MIP3α decreased by 13.7% (р = 0.01). In severe CAP with the underlying ARVI, production of IL-1β changed to a greater extent, increasing by 31.6% (р = 0.039), with the underlying 25.0% decrease in production of MIP3α (р = 0.05) and bFGF (р = 0.039). In patients with mild CAP compared to ARVI, production of IFNα decreased by 104.9% (р = 0.001), with the underlying increase in IL-17A by 63.8% (р = 0.001). Severe CAP, compared with ARVI, was characterized by a decrease in production of IFNα by 65.8% (р = 0.0001), with the underlying increase in the level of IL-17A by 69.9% (р = 0.0001).

CONCLUSIONS: The addition of acute viral infection in patients with bacterial CAP promotes a change in the cytokine profile of blood serum, evidencing a modification of the immune response in such patients, probably, due to a change in the activity of macrophages and T-helpers.

INTRODUCTION: In the Russian Federation, informing schoolchildren of issues of sex education and prevention of sexually transmitted infections (STIs) is regulated by a number of Federal Laws that establish the main principles, rights and responsibilities for parents, teachers, as well as students, in this area. Today, sex education is included in the educational programs of various subjects, such as fundamentals of health and safety, biology and others. A number of academic hours assigned to sex education, may vary depending on the region and educational organizations. Unfortunately, in most cases, the curriculum provides for only a few such classes per year. The Internet resources can significantly improve the awareness of schoolchildren of prevention of STIs attracting them with availability, anonymity and relevance of the information provided, which, however, requires the preliminary assessment by parents, teachers and users themselves.

AIM: To assess the information resource developed for the purpose of informing schoolchildren about issues of STI prevention.

MATERIALS AND METHODS: The study includes the results of an anonymous survey of 435 schoolchildren aged 14–17 years, as well as the results of the assessment of the chatbot by three groups of respondents: 154 students of Sechenov University, 20 members of the teaching staff of Sechenov University, 44 parents of senior high school students. The following study methods were used: analytical, sociological and expert assessments.

RESULTS: Based on the data obtained in the course of study, all the three groups of respondents, in assessing the chatbot, noted the need to increase the level of awareness of adolescents of STI prevention. The respondents also noted that the chatbot is understandable, useful for the learners, contains reliable information that is superior to the information that can be found on the Internet by schoolchildren on their own.

CONCLUSION: Informing schoolchildren of the questions of prevention of STIs plays an important role in formation of the reproductive behavior in the younger generation. The use of Internet resources in the educational programs on STI prevention can be an effective tool for increasing awareness and forming responsible behavior in terms of health issues and reproductive behavior.

INTRODUCTION: Transradial access in catheterization of the coronary arteries is a safe and widely used approach with significantly lower incidence of serious complications compared with the transfemoral access. Since this is the basic form of access used by interventional surgeons dealing with coronary vessel pathology, awareness of its complications is of much importance. Pseudoaneurysm of the radial artery is a rare complication of transradial access with a typical localization of the defect along the anterior wall of the artery. The most common causes include inadequate compression of the puncture site, systemic use of anticoagulants by the patient or the use of sheaths larger than 6 Fr. Early detection and treatment of this rare complication are of great importance.

Aim: To present a clinical case of a patient with a pseudoaneurysm of the radial artery that developed on the first day after injury to the posterior arterial wall.

This paper presents a clinical case of a patient with radial artery pseudoaneurysm resulting from injury to the posterior wall of the artery that occurred during puncture and was successfully closed using tight bandaging.

CONCLUSION: The clinical case is presented due to its rare frequency of occurrence. A careful puncture of the radial artery without damaging the posterior wall will help avoid the development of this complication of coronary angiography. Compression of the puncture site of the pseudoaneurysm neck under ultrasound control can be an alternative to surgical treatment.

INTRODUCTION: Dermatomyositis is a rare autoimmune disease. Its development is often associated with malignant solid tumors. Due to the polymorphism of clinical manifestations and low awareness of the primary care physicians of this disease, dermatomyositis remains undiagnosed for a long time, which leads to a late start of treatment. Untimely start of treatment is associated with a poor prognosis for this group of patients. Factors of poor prognosis include the development and progression of dysphagia and also refractoriness to the standard therapy with systemic glucocorticoids (sGC) and immunosuppressants, when it becomes necessary to use alternative methods of treatment, including intravenous immunoglobulin (IVIG).

AIM: Demonstration of a clinical case of dermatomyositis resistant to high-dose sGC and methotrexate therapy, that required high-dose IVIG therapy.

A clinical case of dermatomyositis in a female patient S., 56 years old, with cutaneous syndrome and muscle weakness, dysphagia and dysphonia is presented. On treatment with prednisolone 1 mg/kg a day orally, methotrexate 15 mg a week subcutaneously, clinical and laboratory dynamics was insignificant, poor tolerance to methotrexate did not permit to increase the dose. Taking into account progressing dysphagia, the medical commission took a decision about high-dose IVIG treatment at a dose 1g/kg once. After four weeks of therapy, clear positive clinical and laboratory dynamics was noted.

CONCLUSION: The described clinical case demonstrated the effectiveness and safety of IVIG for treatment of refractory dermatomyositis with insufficient effectiveness of the previous standard therapy with sGC and immune depressants.

INTRODUCTION: In the modern world, the prevalence of ophthalmological diseases is steadily growing and remains a pressing problem today. Various congenital anomalies of the lacrimal glands, contaminated environment, unbalanced nutrition, taking various medical drugs, wearing contact lenses, irrational use of digital/electronic devices are provoking factors in the development of eye pathology. Chronic processes of the eyelids, such as dry eye syndrome, dysfunction of meibomian glands, blepharitis, blepharoconjunctivitis, recurrent chalazions, significantly reduce the quality of life and working capacity of patients. Disorder in stability of the tear film entails a cascade of pathological alterations. Conservative therapy — artificial tears, thermal applications, anti-inflammatory drugs, antiseptics, antibiotics are unable to provide complete long-term elimination of objective and subjective symptoms. One latest achievement in ophthalmology for these conditions is the use of intense pulsed light (IPL) therapy.

AIM: To analyze domestic and foreign literature sources on the use of IPL-therapy in ophthalmology, to determine the mechanism of its action, effectiveness of this treatment method, its advantages and disadvantages, as well as the possibility to use it for various eye pathologies.

The review summarizes the clinical results of the use of IPL-therapy in ophthalmology, discusses the possibilities of its incorporation in the algorithm of complex treatment of some ophthalmological diseases.

CONCLUSION: IPL-therapy is an effective and safe procedure in some chronic diseases of the anterior segment of the eye.

INTRODUCTION: Solution to the problem of antibiotic resistance (ABR) and the continuing spread of multidrug resistant strains is a strategic task of practical healthcare. An important tool for improving antimicrobial pharmacotherapy, along with active search for new effective drug compounds, can be a detailed investigation of the prime cause of the emergence and effect of the extracellular environment on the molecular mechanisms of bacterial resistance to chemotherapeutic drugs.

AIM: Analysis of the literature devoted to the molecular mechanisms of antimicrobial defense strategy of the bacterial cell against the effect of medical drugs, and to promising strategies of combating antibiotic-resistant agents.

MATERIALS AND METHODS: A search and analysis of the scientific literature was conducted in PubMed, eLibrary, Europe PMC, WoS, CyberLeninka and other databases for the last 5 years. The search queries included the following word combinations: for Russian-language publications the problem of ABR, environmental factors of antibiotic sensitivity, resistance mechanisms, resistance genes, mobile genetic elements; for English-language publications: antibiotic resistance evolution, antibiotic resistance genes, antibiotic resistance in biofilms, transmission of antibiotic resistance. A total of 100 literature sources published from 2018 to 2022 have been analyzed, of which 44 were included in the review.

An analysis of domestic and foreign sources showed that a significant role in the development of ABR in microorganisms is assigned to enzymatic beta-lactamase activity, specific protective proteins of microorganisms, as well as the ability of pathogenic strains to form biofilms. Besides, according to the results of studies, the main source of resistance genes is the environment, where the transfer of ABR genes between representatives of different bacterial taxa occurs. Promising areas in the fight against antibiotic-resistant pathogens are mathematical modeling, synthetic biology, phage therapy.

CONCLUSION: In modern studies, the tendency of microorganisms to ABR presents a serious evolutionary and ecological problem. The uncontrolled and unjustified current use of antibacterial drugs in medicine, veterinary medicine and agriculture provoked the activation of the mechanisms of bacterial cell defense known by the moment, and caused enhancement of the adaptive capacity of bacterial pathogens and spread of multidrug resistant strains. The review also provides data on various strategies aimed at solving the ABR problem.

INTRODUCTION: For many years, there has been a discussion about the appropriateness of using medical eponyms (ME). On the one hand, some of them have already become potentially archaic and misleading. However, on the other hand, in the historical context and association with great scientists and clinicians, they provide emotional involvement in the process of memorizing complicated medical information and create a figurative image of the clinical picture, and in this sense their use can be reasonable, at least from positions of the pedagogical process.

АIM: To analyze historical and modern literature sources with the aim to determine the appropriateness of using ME in the scientific literature and clinical practice on an example of infective endocarditis (IE) as a disease with a large number of well-established ME.

The conducted analysis permitted to distinguish two groups of categories in the discussion of ME. Arguments in favor of refusing ME: (1) they lack precision the same eponym can denote somewhat different concepts, symptoms, diseases; (2) even an honored person was often not the first to describe a certain condition (thus, Osler nodes were not described by W. Osler, and Roth’s spots not by M. Roth); (3) some ME are difficult to memorize due to complex surnames, polysynthetic principle of the formation of the term (three surnames in an eponym is a usual case in medicine); (4) excessive ethnocentricity the predominance of surnames scientists published in certain countries, journals. Needless to say, there is certain subjectivity, tendency of the medical community to stereotyped thinking and an element of accidental in formation of ME. Arguments in favor of preserving ME: (1) they play a significant linguistic, cultural and educational role: being an important characteristic of language and traditions, they bring students closer to the history of medicine and the cultural context; medicine is a science that should strive to a place a human in the center of its interests, both as a patient and as a personality in history; (2) ME facilitates communication between colleagues; historical experience itself has preserved for us necessary, important, valuable ME, at the same time having eliminated a significant part of not very successful terms (thus, speaking about IE, examples of short-term life are the terms ‘Chernogubov’s disease’ and ‘Osler’s endocarditis’).

CONCLUSION: The modern scientific language is based on descriptive terminology. Nevertheless, the authors consider it premature to abandon ME as a phenomenon. The fact that ME preserved within a fairly long historical period and are currently widely used, among other things, in clinical recommendations and international classifications, have demonstrated the usefulness of ME. However, the approach to using ME in clinical practice and scientific publications should be reasonable and rest not only on the historical experience, but also on the current professional standards.