Perm State Medical Academy

Данная работа посвящена анализу нарушений секреторной функции желудка, которые являются ключевым звеном в патогенезе заболеваний желудочно-кишечного тракта. В тексте подробно рассматриваются нейрогенные и гуморальные механизмы регуляции выработки соляной кислоты, включая влияние симпатической и парасимпатической нервных систем, гастрина и гистамина. Обоснована тесная взаимосвязь между количественными сдвигами секреции (гипер- и гипохлоргидрия) и развитием системных осложнений, в частности синдромы мальдигестии и мальабсорбции. Особое внимание уделено патофизиологической классификации типов желудочной секреции (возбудимый, инертный, астенический, тормозной и хаотический), предложенной С.С. Зимницким и переосмысленной в современной медицине. Для каждого варианта подробно раскрыты механизмы патогенеза, этиологические факторы и специфические клинические проявления. Патологические типы секреции характеризуются различными показателями, такими как количество секретируемого желудочного сока за единицу времени, длительность нарастания и убывания секреции. Данные получают на основе анализа результатов фракционного зондирования. Рассмотрено значение метода диагностики в дифференциации тяжелых органических поражений, таких как синдром Золлингера–Эллисона, язвенная болезнь и хронический атрофический гастрит. Работа подчеркивает прогностическую важность оценки динамики секреторного процесса для постановки диагноза.

Pancytopenia, characterized by the simultaneous reduction of red blood cells, white blood cells, and platelets, is a significant hematological complication in individuals living with human immunodeficiency virus (HIV). Its presence often reflects disease progression, immune suppression, and concurrent opportunistic infections. When pancytopenia coexists with congestive heart failure (CHF) - a condition increasingly prevalent among HIV-positive patients due to chronic inflammation, antiretroviral therapy (ART)-associated cardiotoxicity, and aging - the clinical burden intensifies, leading to diagnostic and therapeutic dilemmas. This review aims to examine the underlying mechanisms, diagnostic challenges, and management strategies of pancytopenia in HIV-positive patients with CHF. It explores the multifactorial pathophysiology, including direct viral effects on the bone marrow, drug-induced cytopenias, opportunistic infections, nutritional deficiencies, and CHF-related impairments in erythropoietin and thrombopoietin production. Additionally, the review highlights overlapping symptoms that complicate diagnosis and evaluates current treatment options ranging from ART optimization to hematopoietic growth factors and supportive care.

This review is aimed at the investigation of diagnostic approaches and therapeutic options for patients with chronic cardiac insufficiency with preserved ejection fraction. Chronic cardiac insufficiency with preserved ejection fraction can result from various cardiovascular diseases and is observed in more than 50 % of patients with chronic circulatory failure. Although clinical guidelines exist, the criteria for diagnosing this form of heart failure do not always allow to detect the disease accurately, which can affect subsequent treatment negatively. Modern randomized clinical trials demonstrate that medications from the group of sodium-glucose cotransporter type-2 inhibitors significantly improve clinical outcomes in patients with circulatory failure, justifying their inclusion in treatment regimen. However, the optimal time for starting this therapy is still questionable compared to the administration of other medications recommended for chronic cardiac insufficiency. Considering high incidence, difficulties in diagnosis and treatment for circulatory failure with preserved ejection fraction in practice, the development of practical algorithms for detecting and managing this condition is one of the most important tasks.

Hypertension (HTN) is a serious public health problem. Despite advances in diagnosis and public awareness, the percentage of controlled cases remains low, especially among men and the elderly. The main challenges are related to comorbidities such as obesity, diabetes, chronic kidney disease, and obstructive sleep apnea, which worsen the prognosis and increase the risk of cardiovascular events. The approach to HTN treatment should be individualized and take into account specific disease phenotypes and comorbidities. It is important to identify patients with increased sympathetic nervous system activity, as this group experiences the greatest difficulties in blood pressure control. Moxonidine, a centrally acting agent, selectively stimulates imidazoline receptors in the brain, causing a decrease in sympathetic activity and effective reduction in blood pressure. The need for a personalized approach to HTN therapy is driven by the growing number of patients with multiple comorbidities and complex pathogenesis. New approaches, including early initiation of combination therapy and targeted management of metabolic risk factors, will reduce cardiovascular morbidity and mortality. Moxonidine plays a key role within antihypertensive medications due to its unique mechanism of action and ability to positively impact a wide range of HTN-related pathologies

Endothelial dysfunction (ED) is a key pathogenetic mechanism of many diseases, including chronic liver diseases (CLD). One of the informative and effective ways to assess the presence and severity of ED in CLD is to identify laboratory biomarkers in the blood, which can be used for the assessment of the degree of liver damage and prognosis of the disease. The issues of the physiological role of the endothelium, its functional characteristics and structural and functional features of the endothelium of hepatic hemocapillaries are highlighted in this review, the factors synthesized by the endothelium are presented, ED is characterized and the importance of some biomarkers in the estimation of ED in CLD is described. For a more effective assessment of ED in CLD and correct selection of endothelium protective therapy, a comprehensive approach using laboratory and instrumental methods, or the use of several biomarkers reflecting different functions of the endothelium, are necessary.