The objective of the study was too study the polymorphism of TNFa(rs1800629), IL10(1800871, 1800896) ITGA4(rs1143674, rs1449263), ITGB7(rs11574532) genes in patients with severe ulcerative colitis (UC)

Materials and methods. The study included 70 people with UC who lived in the Irkutsk region, the Republic of Buryatia and the Zabaikalsky krai. Patients were divided into two groups: patients receiving genetically engineered biological therapy (GIBT; n = 22) and patients receiving basic therapy (n=48). The control consisted of 115 healthy volunteers. The genotypes were studied by real-time PCR. For statistical processing, we used the criterion χ2, the odds ratio (OR), binary logistic regression analysis with the calculation of 95% confidence interval (CI) using the program "IBM SPSS Statistics Version 25.0".

Results. Homozygotes of ITGA4(rs1449263)GG had 2.5 times higher chances of developing the disease than carriers of other polymorphic variants (OR = 2,580; 95% CI: 1,129-5,898; χ2 = 5,266; p = 0,022). Patients with extracellular manifestations (ECM) were 3 times more likely to receive GIBT (OR = 3,000; 95% CI: 0,982-9,167; χ2 = 3,878; p = 0,049). IL10 media(1800896)AA prevailed in the group of patients receiving basic therapy (OR = 0,282; 95% CI: 0,089-0,890; χ2 = 5,473; p = 0,020). Subjects with the homozygous variant of ITGA4(rs1143674)CC were 3.5 times more likely to have indications for the administration of GIBT (OR = 3,536; 95% CI: 1,077-11,603; χ2 = 4,576; p = 0,033). The results of binary logistic regression demonstrated that the homozygous genotype of ITGA4(rs1143674)CC and extraintestinal manifestations of the disease were predictors for an unfavorable prognosis of UC accompanied by the GIBT administration.

Conclusion. The association of the debut of the disease, smoking, polymorphic variants TNFa(rs1800629), IL10(1800871), ITGB7(rs11574532) with the UC development and clinical manifestations was not revealed. The disease developed 2,5 times faster in homozygote ITGA4(rs1449263)GG than in other genotype carriers. Subjects with polymorphic variant IL10(1800896)AA prevailed in the group of patients with basic therapy. In addition to the previously known extraintestinal manifestations of the disease, the ITGA4 genotype (rs1143674) CC can act as a risk factor for the development of severe UC, requiring the GIBT administration.

Aim of research – the comparative analysis of the frequency and the identification of factors for the development of acute kidney injury (AKI) in patients with myocardial infarction (MI) with and without the formation of pathologic Q-tooth.

Material and methods. The total of 134 patients were studied and divided into 2 groups: Group 1 – patients with coronary heart disease (CHD) MI with pathologic Q tooth formation (n = 29); Group 2 – CHD MI patients without Q tooth formation (n = 105). Inclusion criteria are first-ever MI, age older than 18 years, increase in serum creatinine level above 26.5 μmol/l within 48 hours and decrease in diuresis less than 0,5 ml/ kg/h, informed voluntary consent for participation in the study. Exclusion criteria are terminal chronic renal failure, age under 18 years, chronic heart failure with left ventricular ejection fraction (LVEF) below 40%, MI anamnesis, refusal to participate in the study.

Results. Among 134 patients with MI, signs of AKI were detected in 40 (29,9%) patients. In group 1, the mean value of glomerular filtration rate (GFR) was 41,0 ± 8,2, in group 2 it was 73,2 ± 13,9 ml/min/1,73m². Signs of AKI in group 1 were observed in 20 (69,0%) patients, in group 2 in 20 (19,0%) patients. The comparative analysis of the study groups revealed that group 1 patients, compared to group 2 patients, had higher body mass index (BMI)(p < 0,001), more often concomitant chronic kidney disease (CKD) was observed (p < 0,001), lower hemoglobin level was typical (p < 0,001), and arterial hypotension was noted at prehospital stage (p = 0,034). In addition, group 1 patients were more likely to develop complications such as bleeding at the site of arterial puncture during percutaneous coronary intervention (PCI) (p < 0,046), pulmonary edema (p < 0,001) and cardiogenic shock (CS) (p < 0,001). The length of stay of group 1 patients in the Intensive Therapy and Resuscitation Department was 11,5 ± 3,6 bed days, group 2 was 9,6 ± 3,9 bed days (p < 0,019), and 8 (27,6%) patients and 1 (1,1%) died, respectively (p < 0,001).

Conclusion. Early signs of AKI were detected in 29,9% of patients with MI; this condition was more frequent in the group of patients with MI who had a formed pathologic Q wave (69%). High BMI (p = 0,02), increased blood levels of HDL (p < 0,006) and total cholesterol (p < 0,001), decreased blood hemoglobin (p = 0,001), arterial hypotension (p = 0,013) and initial CKD (p < 0,001) were the factors contributing to the development of AKI.

Objective. To study the effect of therapy for adrenal and thyroid dysfunction on the course and outcomes of critical care.

Materials and methods. 51 patients requiring targeted temperature management (ТТМ) were included in a single-center prospective cohort study.

Results. Group I (with adrenal and thyroid dysfunction) included 39 (76,5%) patients on TTM, group II (without adrenal and thyroid dysfunction ) included 12 (23,5%) patients without endocrinopathies. In patients on TTM, adrenal dysfunction developed on day (D) 0 and manifested only clinically in the form of vascular insufficiency. When evaluating clinical and laboratory data in patients at TTM, thyroid dysfunction was diagnosed at D1, D2, and D3. The manifestation of adrenal and thyroid dysfunction in patients at is primarily due to central nervous system injury rather than sepsis. Treatment of adrenal and thyroid dysfunction was performed with hydrocortisone and levothyroxine.

Conclusion. Formation of combination of adrenal and thyroid dysfunction at TTM leads to the development of multiple organ dysfunction not associated with the development of septic complications. Timely diagnosis and adequate correction of adrenal and thyroid dysfunction in patients undergoing critical illness and requiring TTM allows to reliably reduce mortality.

The aim of the research. To identify prognostic factors for the development of sepsis in postpartum women who have suffered critical obstetric conditions (CAC).

Materials and methods. We retrospectively examined 39 postpartum women after CAC, who were divided into groups: A – main group, with advanced sepsis (n = 18), B – control group without sepsis (n = 21). An analysis of clinical data upon admission was carried out. The results were processed using Statistica 12.0, Microsoft Excel and in the R environment.

Results. Statistically significantly more often, patients in the main group gave birth before the 34th week of pregnancy, p = 0.04. About 50% of the subjects gave birth in first-level maternity facility. Preeclampsia and obstetric hemorrhage were the main causes of CAC development. Hemorrhagic shock occurred in 84,6% of subjects. All women underwent total hysterectomy. Sepsis developed on day 9 (4; 9) after delivery. It was shown that the chance of developing obstetric sepsis is 28 times more often in the case of artifical ventilation and at AVPU, 10 times – in case of adult respiratory distress syndrom, 7 times – in case of developed kidney failure, 6 times – in case of cerebral edema. When assessing the condition of postpartum women using the integral scales APACHE II, APACHE III, SOFA, NEWS2, a statistically significant OR in the development of sepsis remains only for the NEWS2 index; with a score of 4 points, the resulting model predicts the development of sepsis. The risk of developing obstetric sepsis is associated with MNO ≥ 1,13, CVP ≥ 6 and ASAT ≥ 45; in the presence of at least one of these factors, it increases by 7-8 times in terms of odds ratio (OR).

Conclusion. The risk of developing obstetric sepsis in critical obstetric conditions is associated with the presence of mechanical ventilation and AVPU, adult RDS, renal failure, cerebral edema, a NEWS2 score of 4 or more points, MNO ≥ 1,13, CVP ≥ 6 and ASAT ≥ 45. The effectiveness of the developed prognostic model is: sensitivity – 94,5%, specificity – 90,5%.

The aim of the research. To study the features of the course of osteomyelitis in rats during the induction of an infectious and inflammatory process by various pathogens under conditions of early and delayed local exposure to direct electric current.

Materials and methods. The study was carried out on 53 Wistar rats, divided into 3 series. In each series, osteomyelitis of the femur was modeled by direct inoculation into the femoral canal of a monobacterial culture (Staphylococcus aureus; MSSA, museum strain, or Pseudomonas aeruginosa, museum strain, or Escherichia coli, museum strain) at a concentration of 1 × 108 CFU and placing an intramedullary metal implant. The animals of each series were divided into 3 groups. In group 1, no additional manipulations were performed with the animals; in groups 2 and 3, the source of infection was exposed to a direct electric current (150 mAm, 1 minute) on days 0, 2, 4 and 6, or on days 7, 9, 11 and 13. The duration of the experiment was 21 days.

Results. All animals had a clinical picture characteristic of osteomyelitis, but the nature, severity and frequency of occurrence of signs of the infectious-inflammatory process in the groups were different.

Conclusion. Exposure to electric current early after infection had the most pronounced antimicrobial effect against P. aeruginosa when exposure began on day 7 after infection. A less pronounced effect of electrical exposure was noted in relation to S.aureus and E.coli when exposure began on the first day after infection.

Aim of the research. The aim is to study the content of intercellular adhesion molecules (ICAM-1), vascular cell adhesion molecule (VCAM-1) and calprotectin in the blood serum of patients with type 2 diabetes mellitus and various stages of diabetic retinopathy. The aim is also to evaluate the role of these molecules in the pathogenesis of the disease.

Materials and methods. Four groups of people were formed: first group (control group) included 21 healthy individuals; second group included 21 patients with prediabetes, third group 21 patients with type 2 diabetes. The fourth group included 63 patients with diabetic retinopathy, and this group was further divided into 3 groups of 21 people each: with non-proliferative stage of DR, with preproliferative stage, with proliferative stage..

The concentrations of ICAM-1, VCAM-1 and calprotectin (MRP8/14) in blood serum were determined using Human Vascular Inflammation Panel 1 multiplex analysis kits from Biolegend (USA). The results were assessed using CytoFlex flow cytometer (USA). The results were calculated using Jamovi version 2.3.

Results. In individuals with prediabetes, the content of MRP8/14 was increased by 111,7% (p < 0,001) relative to the control group. In type 2 diabetes without retinopathy, the values of MRP8/14 protein exceed the control group values by 2,7 times (p < 0,001) and those in individuals with prediabetes by 29,2% (p = 0,049). In the group of patients who had non-proliferative stage of DR, the levels of ICAM-1, VCAM-1 and MRP8/14 are higher than control group values in the groups of people with prediabetes and patients with diabetes without complications. During the preproliferative stage, the number of adhesion molecules increases even more; during the proliferative stage, the concentrations of VCAM-1 and calprotectin remain high, and the level of ICAM-1 increases relative to the previous stages.

Conclusion. Increasing of MRP8/14 level in diabetes and increasing of ICAM-1 and VCAM-1 concentrations in the initial stage of DR demonstrate the role of these molecules in the initiation of DR in type 2 diabetes. Researching the relationship between these markers and the development of DR can provide additional information to develop strategies for prevention and treatment of DR as well as predicting its complications.

In pediatric practice, septic shock (SS) is a serious, urgent condition with a high incidence and increased risk of death. Intensive therapy in this condition is based on provision of volume-expansion fluid management, prescription of antibiotic medications, and vasopressor support. Urgent care for children is provided in an intensive care unit and includes mandatory determination of the aetiology of SS (by inoculation of blood samples for sterility), provision of venous access and continuous monitoring of vital signs with measurement of lactate levels. The intensity of respiratory support changes according to the following stepwise logic: oxygen therapy – non-invasive ventilation – mechanical ventilation. When providing fluid management to a patient with SS, preference is given to crystalloid solutions. Antibacterial therapy is devised empirically and must be administered within the first hour of ICU admission. If fluid management proves insufficient to ensure stable hemodynamic parameters, vasopressor support is provided by administering inotropic agents, vasodilators and inodilators (norepinephrine, epinephrine, dopamine and dobutamine). Evidence on the effectiveness of corticosteroids in children and adolescents with SS is lacking. Knowledge of the latest algorithms of intensive treatment of SS in pediatric practice will enhance the quality of care and improve the therapeutic prognosis in this category of patients.

Examination of the level of consciousness is one of the basic elements of assessing patients in a life-threatening condition. Depression of the consciousness influence on the patient’s severity, therapy planning. The dynamic assessment is carried out at the prehospital stage, as well as in intensive care units. Domestic and foreign literature sources were studied to determine the optimal tool and algorithm for its use in assessing the level of consciousness of patients delivered by emergency medical services. The analysis of the works from the scientific databases PubMed, eLibrary, Google Scholar, MedRxiv devoted to the diagnosis and treatment of patients with a reduced level of consciousness was carried out.

The Full Outline of Unresponsiveness (FOUR) scale and the Glasgow Coma Scale (GCS) have an equally high level of psychometric parameters when assessing patients in general intensive care, however, the assessment of brainstem reflexes included in the FOUR scale makes it optimal for triage and dynamic monitoring of patients during ongoing treatment.

Glycocalyx (GC) is represented by protein-polysaccharide compounds lining the inner surface of endothelial cells in the form of a gel. GC plays an important role in the regulation of vascular homeostasis, controls vascular wall permeability and microvascular tone, prevents microvascular thrombosis and participates in the regulation of leukocyte adhesion. Damage of endothelial HA is a part and initial link of pathophysiological processes underlying the development of complications of diabetes mellitus (DM). In most cases of DM is accompanied by degradation of HA caused by hyperglycemia, which leads to impaired microcirculatory perfusion and organ dysfunction. Further study of HA, determination of its contribution to the development of diabetes complications is a very promising area of research. In this review, we analyze the main mechanisms of destruction and the role of HA in the pathophysiological mechanisms of the development of DM complications. Although numerous studies indicate a significant role of HA dysfunction in the development of micro- and macroangiopathies in the outcome of diabetes, many aspects of pathophysiological processes are still unexplored and require further research.

The review article presents an analysis of scientific articles indexed in the PubMed and Web of Science databases on the pathophysiological and clinical features of acute renal injury in patients with a new coronavirus infection. In addition to the direct damaging effects of the SARS-CoV-2 virus on the kidneys and the systemic consequence of viral infection, there are common damaging factors of acute renal injury for all critical conditions. Data on the direct damaging effects of the virus and the systemic consequence of viral infection are contradictory and require further research. Hypovolemia is common in the early stages of COVID-19, so emergency fluid administration is critical for the prevention and treatment of acute kidney injury in patients with novel coronavirus infection. Optimization of liquid volume in order to prevent and prevent the progression of AKI to a severe degree requiring renal replacement therapy is of particular importance when resources are limited in a pandemic.

Epidemiological data indicate high rates of morbidity and mortality of oral mucosal cancer worldwide. At the same time, even visual accessibility does not allow detecting oral cancer in the early stages.

The purpose of the study. Assessment of the involvement of cytokines in the development and progression of oral cancer.

Materials and methods. The search for publications was carried out in the databases of the RSCI, PubMed, Scopus 2019-2023 years for the following queries: cancer of the oral mucosa; potentially malignant diseases of the oral cavity; precancerous diseases of the oral cavity, inflammation and cancer, cytokines, saliva cytokines, serum cytokines.

Results. It is now recognized that under the influence of inflammation, neoplastic and stromal cells interact and control tumor evolution by producing cytokines. Modern studies demonstrate the important role of cytokines such as TNF-α, IL-8, IL-6, IL-1β in the development and progression of oral cancer. A review of the conducted studies indicates that cytokines released by tumor cells of oral cancer, as well as the tumor microenvironment, contribute to cell proliferation, survival, and migration of tumor cells of this localization, although they activate immune cells, contributing to the modulation of the antitumor immune response. Hyperproduction of cytokines, registered at the local and systemic levels, appears to be a consequence of dysregulation of proliferative processes and at the same time one of the causes of tumor spread.

Conclusion. Modern research demonstrates the important role of various cytokines in the development and progression of cancer of the oral mucosa. In this regard, therapeutic approaches that limit their growthstimulating activity should be considered.

For the last decade, the attention of researchers has been attracted by Toll-like receptors that provide recognition of pathogens and trigger an immune response to them. As participants in acute infectious processes, with inadequate stimulation associated with mutation of genes regulating expression of the receptors, they cause the initiation or exacerbation of asthma in predisposed individuals. At the same time, the reduced function of the receptors leads to an insufficient immune response in respiratory infectious diseases, which also leads to an exacerbation of bronchial asthma. In addition, Toll-like receptors are direct elements of the pathogenesis of bronchial asthma, supporting or reducing inflammation. Thus, Toll-like receptors can not only aggravate the course of asthma, but also prevent exacerbations of the disease. Knowledge of the role of these receptors in the pathophysiology of bronchial asthma is necessary to improve diagnostic methods and timely detection of the disease. Using data on the effects realized by the receptors, medicines are being developed that are antagonists or agonists of a Toll-like receptors. The use of medicines acting on receptors in the treatment and prevention of asthma in the future may lead to increased control over the course of the disease.

Asherman's syndrome is a mysterious, multifaceted disease characterized by the formation of
intrauterine synechiae, up to complete obliteration of the uterine cavity. This is a very controversial topic
because of its pronounced effect on both the reproductive prognosis (infertility, habitual miscarriage) and
gynecological symptoms (menstrual dysfunction of the type of oligo-amenorrhea). Although the syndrome
has been extensively studied, there is no clear evidence of both its prevention and effective treatment. The
main reason for the formation of intrauterine adhesions is recognized by most authors as endometrial injury.
Understanding the pathogenesis of their formation is necessary to prevent the development of endometrial
fibrosis and sclerosis. The review article presents in detail the causes of the disease, risk factors, clinical
manifestations, and methods for diagnosing this syndrome. Therapeutic measures are presented in step-bystep low-traumatic ways to eliminate intrauterine adhesions with subsequent restoration of menstrual and
reproductive functions. Particular attention is paid to anti-relapse prevention through the prescription of
intrauterine anti-adhesion gels.

Every pediatrician-nephrologist repeatedly have to deal with cases of the birth of children
with early onset of nephrotic syndrome, which is characterized by a severe course, persistent progression of
symptoms, resistance to standard immunosuppressive therapy, questionable and, often, unfavorable prognoses
for life and health, which requires constant improvement of existing professional knowledge, diagnostic and
therapeutic skills. The article presents a review of the scientific literature of domestic and foreign authors,
which allows changing the perception of the disease, improving outcomes, giving chances to the patient and
his family in conditions of modern and timely diagnosis and the correct choice of patient management strategy.

Differentiated vulvar intraepithelial neoplasia (dVIN) is an obligate precancer, develops during chronic vulvodermatoses, such as lichen sclerosus and lichen simplex chronicus. The epidemiological, clinical, pathomorphological, diagnostic, and prognostic features of dVIN are discusses. A clinical case of interdisciplinary management of a patient with dVIN, complicated by malignancy and urethral stricture, is presented. Early oncological alertness was demonstrated, microinvasive vulvar cancer in woman with of lichen sclerosus was diagnosed. It is actually, because there is high amount primary patients with advanced vulvar cancer. The joint work of oncologists, urologists, and gynecologists made it possible to successfully perform reconstructive plastic surgery for urethral stricture using a buccal graft for the first time in the Trans-Baikal Territory. Thanks to this the urinary function was restored and the quality of life improved.

There are primary and secondary hyperammonemia. Primary hyperammonemia is a hereditary disorder of the urea formation cycle. Secondary hyperammonemia can occur both in hereditary diseases (mitochondrial diseases, organic aciduria/aminoacidopathies) and in asphyxia suffered in childbirth, liver damage of various etiologies (toxic, infectious, etc.), extrahepatic portal hypertension, renal failure, infections caused by urease-producing microorganisms, diseases accompanied by increased catabolism, etc. transient nature. Regardless of the etiology, hyperammonemia can cause irreversible damage to brain cells, which determines the exceptional importance of early diagnosis and timely therapy.