Introduction. Community-acquired pneumococcal pneumonia is characterized by a severe course in patients with metabolic syndrome (MetS); however, the influence of various combinations of its components remains poorly understood. This study performed stratification of patients according to the component composition of MetS with an assessment of markers of systemic inflammation and endotoxemia.Aim. To evaluate the features of the systemic inflammatory response in patients with pneumococcal pneumonia depending on the criteria of metabolic syndrome, with assessment of the leukocyte index of intoxication and markers of inflammation.Materials and methods. A prospective comparative cohort study included 38 patients with pneumococcal pneumonia, stratified into 3 groups according to the criteria for metabolic syndrome (IDF, 2005). Blood sampling was performed within the first 24 hours of hospitalization, followed by determination of endotoxin level (LAL test), markers of inflammation (interleukin-6, tumor necrosis factor-alpha, C-reactive protein, procalcitonin), immune status (CD4+/CD8, lymphocyte subpopulations), and calculation of the leukocyte index of intoxication.Results. The most pronounced disturbances in immune status and endotoxemia indicators were registered in patients of group A (abdominal obesity + type 2 diabetes + arterial hypertension + dyslipidemia), where an increase in endotoxemia level to 1.46 [1.29; 1.55] EU/ml, leukocytosis (14.8±1.3 ×10⁹/L), neutrophilia (81.8±3.1%), lymphopenia (14.8±2.5%), and an increase in the leukocyte index of intoxication to 9.4±1.4 were noted. An imbalance in the immunoregulatory index was revealed due to a decrease in CD4+ lymphocytes (33.8±2.2%) with a simultaneous increase in CD8+ cells (30.6±2.2%), indicating impaired regulation of the immune response. Indicators of patients in group B (abdominal obesity + type 2 diabetes + reduced high-density lipoprotein cholesterol (HDL-C) level) and group C (abdominal obesity + arterial hypertension + hypertriglyceridemia) demonstrated statistically significantly less pronounced changes in both immunological parameters and endotoxemia level.Conclusion. The most unfavorable profile, characterized by the maximum level of endotoxemia, hyperactivation of the cytokine cascade (interleukin-6, tumor necrosis factor-α, C-reactive protein, procalcitonin), and signs of immune dysregulation (decreased CD4+/CD8+ ratio, high leukocyte index of intoxication), was formed in patients of group A, which combines abdominal obesity, type 2 diabetes, arterial hypertension, and dyslipidemia.
Background. Hypertrophic cardiomyopathy (HCM) is a genetically determined disease characterized by left ventricular hypertrophy of various localizations, including asymmetric septal, concentric, and apical morphotypes, myocardial fibrosis, myofibrillar disorganization, and predisposition to sudden cardiac death. Feature Tracking cardiac MRI allows quantitative assessment of myocardial strain regardless of HCM morphotype; however, comprehensive analysis of synchronization parameters (time-to-peak, TTP) and strain rate in Russian patient cohorts remains limited.Purpose. To determine the characteristics of global and segmental myocardial deformation, temporal parameters, and strain rate of the left ventricle in patients with HCM using cardiac MRI with Feature Tracking technology.Materials and Methods. Analysis included 74 patients with confirmed HCM diagnosis who underwent 3.0T cardiac MRI. Using CVI 42 software, the following parameters were determined: global longitudinal strain (GLS), circumferential strain (GCS), and radial strain (GRS) in percentages; time-to-peak (TTP) parameters for each deformation direction; peak systolic strain rate. Comparison was performed with published reference values for healthy volunteers at 3.0T. Patient risk stratification was performed based on GLS values.Results. GLS was significantly reduced (–7.22±4.43% vs normal –16.9±1.8%, p<0.001), GCS was moderately reduced (–16.21±3.16% vs normal –19.2±2.1%, p<0.001), and GRS was compensatorily elevated (45.52±21.60% vs normal 34.2±6.1%, p<0.001). TTP dispersion was 80.9±21.9 ms, exceeding normal values 1.6-fold, indicating pronounced mechanical dyssynchrony (88.4% of patients with SD > 50 ms). Risk stratification revealed that 60% of patients demonstrated critically reduced GLS values (> –8.35%), which is associated with poor prognosis in recent studies. Identification of such severe dysfunction suggests the need for comprehensive risk stratification for sudden cardiac death, as outlined in the 2023 ESC guidelines.Conclusions. Feature Tracking 3.0T cardiac MRI reveals a characteristic deformation pattern in HCM with pronounced GLS reduction, moderate GCS reduction, and compensatory GRS elevation. Pronounced mechanical dyssynchrony may serve as an arrhythmia risk marker. The majority of this cohort demonstrates critical GLS values requiring careful sudden cardiac death risk stratification.
Liver transplantation is a radical treatment for end-stage liver disease. Improved transplantation outcomes have led to an increasing number of women of reproductive age with functioning grafts, making pregnancy after liver transplantation an important clinical issue. Pregnancy following liver transplantation is associated with increased risks for both mother and fetus, including complications related to immunosuppressive therapy, graft dysfunction, and comorbidities.Objective. To analyze pregnancy cases in women after liver transplantation, evaluate current research and international guidelines for patients of reproductive age following liver transplantation, and identify risk factors affecting pregnancy outcomes and maternal-fetal health.Materials and methods. A literature search was conducted in PubMed, Scopus, Web of Science, eLibrary.ru, and Google Scholar databases for the period 2014-2025 using keywords: liver transplantation, pregnancy, pregnancy outcome, immunosuppressive therapy, rejection, preeclampsia. Inclusion criteria were original studies, systematic reviews, meta-analyses, clinical cases, and professional society guidelines. Exclusion criteria included publications without full-text access and duplicate data. A total of 36 sources were analyzed.Results and discussion. According to literature data, live birth rates after liver transplantation range from seventy to eighty percent, however rates of preterm delivery (thirty to forty percent), preeclampsia (twelve to fifteen percent), and cesarean section (forty to fifty percent) significantly exceed those in the general population. Risk of graft rejection during pregnancy is three to ten percent. Major maternal complications include gestational hypertension, preeclampsia, gestational diabetes, and infectious complications. Most common fetal complications are intrauterine growth restriction, prematurity, and low birth weight. International guidelines emphasize the need for pregnancy planning no earlier than one to two years post-transplantation with stable graft function and absence of rejection episodes, as well as adjustment of immunosuppressive therapy to pregnancy-safe medications. Primary drugs of choice are tacrolimus and cyclosporine, while mycophenolate mofetil should be replaced with azathioprine at least six weeks before planned conception. Pregnancy management requires careful multidisciplinary monitoring involving a transplant surgeon, high-risk obstetrician, and neonatologist.Conclusion. Pregnancy after liver transplantation is a complex process requiring a multidisciplinary approach and careful monitoring. Despite improved prognosis, pregnancy in these cases carries increased risks. Further research is needed to optimize pregnancy management, develop strategies to reduce graft rejection risk, and minimize complications.
Introduction. Freiberg–Köhler disease is a rare form of osteochondropathy of the second metatarsal head characterized by avascular necrosis, destruction of the articular surface, and secondary osteoarthritis. The disease predominantly affects adolescent and young adult females and is accompanied by severe pain, limited mobility, and foot deformity. Even with early diagnosis, conservative treatment is often insufficient to prevent disease progression, making surgical intervention necessary.Aim: To evaluate the effectiveness of the collagen membrane Chondro-Scaffold in the surgical treatment of Freiberg–Köhler disease.Object and methods. A retrospective analysis of clinical data from 28 patients was performed to assess the effectiveness of a technique combining shortening osteotomy and implantation of the Chondro-Scaffold collagen membrane using functional (AOFAS and VAS) and radiographic parameters. Postoperative follow-up was carried out at 3, 6, and 12 months.Results. The use of the Chondro-Scaffold collagen membrane resulted in a significant improvement in foot function, as demonstrated by an increase in the AOFAS score from 46.2 to 89.5 and a decrease in pain intensity from 7.6 to 1.5 according to the VAS scale.Conclusion. The use of the Chondro-Scaffold collagen membrane is a promising approach in the surgical treatment of Freiberg–Köhler disease, leading to improved clinical and functional outcomes and enhanced patient quality of life. Further studies are required to evaluate long-term effectiveness.
Introduction. Musculoskeletal diseases and injuries are a pressing problem for millions of people. Damage to the hyaline cartilage leads to further degradation of the articular surface. Conservative treatment methods are ineffective, and at the final stage, a highly traumatic, costly procedure of joint arthroplasty is required. After it, in 3% of cases, complications occur in the form of periprosthetic infection, the treatment of which requires significant additional economic costs, reducing the quality of life and increasing the risk of disability of patients. Of particular interest is the prediction of recurrence of periprosthetic infection associated with the chronicity of the process and a significant increase in the duration of treatment and its costs.The aim of the study. Creation of a structured database for subsequent analysis of factors influencing the risk of recurrence of periprosthetic infection of the hip joint using the Python programming language based on archival data of patients with hip joint arthroplasty.Materials and methods. The work was carried out using information about patients with periprosthetic infection of the hip joint, who were treated at the Center in the period from 2010 to 2022. Discussion. The obtained data allow predicting the risk of recurrent PJI, as well as analyzing the causes leading to it, which will allow adjusting the further treatment regimen for such patients in order to avoid or minimize the development of recurrent periprosthetic infection.Results. A structured database of cleaned and prepared data for further analysis was obtained with 1611 unique patients, each of whom was described by 101 unique attributes. The possibility of predicting the risk of developing periprosthetic infection based on the information obtained using an automatic algorithm was shown.Conclusion: further analysis of the data bank will allow us to deepen our understanding of the causes of recurrent periprosthetic infection and consolidate the experience of traumatologists and orthopedists regarding the management of this cohort of patients.
