Obstructive sleep apnea syndrome (OSAS) is one of the most common and clinically significant sleep-related breathing disorders in adults. OSAS is associated with cardiovascular pathology, metabolic disorders, increased mortality, and reduced quality of life. A significant proportion of patients with OSAS also suffer from arterial hypertension (AH), including resistant hypertension, and hyperuricemia. Current data suggest that these three conditions form a single high-risk cardiometabolic phenotype. Intermittent hypoxia in OSAS enhances purine catabolism and increases uric acid production, while also inducing increased sympathetic activity, endothelial dysfunction, and activation of the renin-angiotensin-aldosterone system. Hyperuricemia, in turn, is considered not only as a predictor of gout, but also as an independent cardiovascular risk factor, associated with the development and worsening of AH, progression of kidney damage, and vascular wall remodeling. Genetic factors play an additional role, including polymorphisms of uric acid transporter genes (SLC2A9/GLUT9, SLC22A12/URAT1, ABCG2), vascular tone regulation genes (ACE, eNOS), and hypoxia response genes (HIF1A). This review discusses the epidemiological, pathophysiological, and genetic relationships between OSAS, hyperuricemia, and AH, as well as the clinical implications for risk stratification and patient management.
The article is dedicated to the 70th anniversary of the famous scientist, teacher, Head of the Department of Microbiology, Virology and Immunology, Doctor of Medical Sciences, Professor Vladimir Mikhailovich Sheibak.
Background. In 2022, the number of kidney transplants performed worldwide totaled 102,149. According to various sources, individual vascular variations of the kidney's extra-organ vessels were detected in 3.3-47% of cases. Studies on renal vascular morphology are limited. There is no consensus on the prevalence of multiple renal vessels. Objective. To evaluate the prevalence of vascular anatomical variations in kidney transplants. Material and Methods: The vascular anatomy of 287 renal transplants was analyzed to identify arterial, venous, or combined arterial-venous vascular variations. Results. Individual vascular variation was detected in 77 (26.8%) cases. Of these, variations in the arterial vascular bed were found in 64 (22.3% of the total number of donor kidneys), in the venous vascular bed – in 4 (1.4%), in the arterial-venous vascular bed – in 9 (3.1%). The most common variation was the presence of an additional inferior polar artery (IPA) in 31 donor kidneys (40.3% of the total number of variations). Conclusion. Individual vascular variation of renal transplants, which was detected in 26.8% of cases, makes it difficult to perform surgeries aimed at adequate organ revascularization during transplantation and can lead to serious complications. This necessitates clear indications for the specific type of reconstruction, depending on the vascular variation.
Background. The immunoregulatory cytokine TGF-β1 and toll-like receptors 2 (TLR2) and 4 (TLR4) play a role in the immune tolerance development in the first years after birth. Genetic polymorphisms of TLR2, TLR4, and TGF-β1 may contribute to predisposition to allergic disease. Objective. To determine the frequency of alleles and genotypes of polymorphic variants of the TLR2 gene (Arg753Gln), TLR4 gene (Asp299Gly, Thr399Ile) and TGF-β1 gene (Arg25Pro) in children residing in Grodno region, as well as to evaluate the association of these polymorphisms with the risk of developing allergic rhinitis and recurrent airway obstructions in the first three years of life. Material and methods. A total of 355 children residing in the western region of Belarus were enrolled in the prospective cohort study. The children were observed by a pediatrician and an allergist from birth to 3 years of age. Genetic polymorphisms of the TLR2 gene (Arg753Gln (rs5743708)), TLR4 gene (Asp299Gly (rs4986790), Thr399Ile (rs4986791)), and TGF-β1 gene (Arg25Pro/G915C (rs1800471)) were determined in 182 children using Real-Time PCR. Children with recurrent symptoms of respiratory pathology (30/182) were included in the study group (SG): 14 children with allergic rhinitis (AR), 13 children with recurrent wheezing (RW), and 3 children with recurrent croup. The rest of those evaluated for genetic polymorphisms (152/182) were included in the comparison group (CG). Results. The frequency of the homozygous mutant AA genotype of the Arg753Gln polymorphism in the TLR2 gene was 23.08% in children with RW and 0.66% in the CG (p=0.0001). The relative risk (RR) for RW in AA genotype carriers (Arg753Gln) was 10.44 (95% CI 4.10-26.59). The frequency of the homozygous mutant CC genotype of the Arg25Pro polymorphism in the TGF-β1 gene was 16.67% in children with AR, while in the CG it was 3.45% (p=0.03). The RR for developing AR in CC genotype carriers (Arg25Pro) was 4.05 (95% CI 1.06-15.50). Conclusion. Carriage of the mutant homozygous genotype AA of the TLR2 Arg753Gln polymorphism and the mutant homozygous genotype CC of the TGF-β1 Arg25Pro polymorphism were associated with a significantly higher risk of early manifestation of recurrent wheezing and allergic rhinitis respectively. There was no statistically significant difference between the groups for Asp299Gly и Thr399Ile polymorphisms of the TLR4 gene.
The presented clinical case describes the diagnosis and successful X-ray endovascular treatment of critical stenosis of the pulmonary valve and coronary arteries during the subacute period of myocardial infarction and stroke in a 42-year-old patient with previously repaired Tetralogy of Fallot, who was admitted to the Grodno Regional Clinical Cardiology Center. Due to the uniqueness of this clinical case, it may be of great clinical interest.
Background: The development and widespread introduction of highly effective direct-acting antiviral drugs (DAAD) into practical healthcare is a critical component of eliminating chronic hepatitis C. Currently, the criterion for treatment effectiveness is the absence of hepatitis C virus (HCV) RNA in plasma, as determined by a molecular biological blood test for hepatitis C. HCV core antigen (HCV-cAG) is a serological marker of HCV replication, which is used as a confirmatory test to verify chronic hepatitis C and assess the effectiveness of DAAD therapy. Study objective: To evaluate the diagnostic accuracy of HCV-cAG as a criterion for the effectiveness of DAAD therapy for chronic hepatitis C. Material and Methods. The study included 51 patients with chronic HCV infection, and without HIV/HCV coinfection, who completed DAAD therapy and achieved a sustained virological response at week 24 post-treatment, as determined by plasma PCR (HCV RNA "-") using the AmpliSens HCV-Monitor-FL (for the quantitative determination of HCV RNA in clinical specimens by PCR with real-time fluorescence hybridization detection). HCV-cAG was detected by immunoassay using an automated immunoassay analyzer. Results. Patients receiving antiviral therapy showed a significant decrease in HCV-cAG after achieving sustained virological response to DAAD treatment, which correlated with PCR results. The median (Q1; Q3) HCV-cAG level in the study group was 2.9 (2; 3.9) fmol/L. The HCV-cAG level for confirming a sustained virological response to DAAD therapy equal to or less than 8 fmol/L coincided with an undetectable HCV RNA viral load according to PCR diagnostics in 96.1% (95% CI: 86.8-98.9). Conclusions. The HCV-cAG level for confirming a sustained virological response to DAAD therapy coincided with PCR results, indicating the high informativeness of this method for assessing the effectiveness of DAADs. If the HCV-cAG level is greater than 8 fmol/L after DAAD treatment, PCR for HCV RNA in blood plasma is recommended.
Background: ethacizine is an effective class IC antiarrhythmic agent used for the treatment of ventricular rhythm disorders; however, its use is limited by a narrow therapeutic window and a substantial proarrhythmic potential, particularly in patients with structural myocardial abnormalities. Objective: to present a clinical case of ethacizine overdose in a neurosurgical patient with symptomatic premature ventricular complexes in the form of ventricular bigeminy during the preoperative period. Clinical case presentation: a single dose of four ethacizine tablets (200 mg) resulted in atrioventricular and intraventricular conduction disturbances, including first-degree atrioventricular block with a PQ interval of 0.26 s, complete left bundle branch block with QRS widening up to 0.20 s, QT prolongation to 0.48 s, and secondary ST-T abnormalities mimicking acute coronary syndrome. Hemodynamic status remained stable, while cardiac biomarkers of myocardial necrosis showed no clinically significant elevation. Under active monitoring complete normalization of electrocardiographic findings has been noted within 24 hours. Conclusions: this clinical case highlights the importance of strict adherence to recommended ethacizine dosage, careful ECG monitoring and compliance with current approaches to the management of premature ventricular complexes.
The article is devoted to the problem of predicting the risk and prevention of sudden cardiac death (SCD) in the general human population and in heart diseases. Approaches to SCD risk stratification at the population and individual levels based on clinical, instrumental, and genetic diagnostic and screening methods are discussed. Preventive and therapeutic strategies in the aspect of cardiac arrest and SCD are considered. The problem of determining the individual risk of SCD for individuals from the general population is currently difficult and has not been unequivocally solved. Stratification of the risk of ventricular tachyarrhythmias and SCD in high-risk patient groups allows to determine a preventive strategy. The basis of this strategy is the use of implantable cardioverter defibrillators. In the population of patients with heart failure, the use of optimal drug therapy can reduce the risk of general, cardiovascular, and sudden cardiac death. Early diagnosis of rare diseases (cardiomyopathies, channelopathies) will make it possible to inform about potential triggers of ventricular tachyarrhythmias, conduct timely recognition and confirmation of life-threatening arrhythmias, stratify the risk of SCD and determine a preventive treatment strategy.
Acute kidney injury is a heterogeneous severe syndrome with a high risk of mortality, which is potentially reversible with timely diagnosis and treatment. Therefore, particular attention is paid to the prediction and early diagnosis of impaired renal function. Novel biomarkers play an important role in detecting abnormalities in high-risk groups. The significance of each of them and their combinations provides a new perspective on diagnostic approaches to kidney disease.
Animal-assisted therapy is a method of medical rehabilitation based on the use of pets. Dogs, cats, and horses are most commonly used. The objectives of the method are to reduce anxiety and stress, provide emotional support, improve coordination of movements in patients with neurological pathology and expand motor activity in patients with neurological and cardiovascular diseases. Interaction with dogs increases person's oxytocin levels and lowers cortisol levels in the blood. The cat's purring, which is in the frequency range of 27-44 Hertz, reduces anxiety and activates tissue regeneration. Hippotherapy improves coordination of movements, spatial orientation, psycho-emotional state of the patient, increases their self-esteem and improves socialization.
Ground glass opacity which is determined by a high-resolution computed tomography is characterized by a localized decrease in lung airflow without obliteration of the bronchi and blood vessels. The nonspecific nature of this symptom, observed in a wide range of diseases (including pneumonia, interstitial diseases, and cancer), requires careful differential diagnosis. This article examines various clinical situations associated with ground-glass opacities using specific examples which allow improved diagnostic accuracy in healthcare practice.
Background. The state of the blood-brain barrier (BBB) depends on external factors, including neuroinfectious agents, and on the internal environment of the human body, represented by various structural components of the brain's neurovascular system. Objective: To present the structural and functional characteristics of BBB components and the main markers of BBB damage in pathological conditions and neuroinfections. Material and Methods. An information search was conducted on accessible websites of the computer databases MEDLINE, e-LIBRARY, SpringerLink, Ebsco HOST, and PubMed, using key terms related to the stated structural and functional characteristics of the BBB, as well as its damage and impaired permeability during neuroinfections. Results. Separate sections of the review contain information on the structural and functional characteristics of the BBB, its functions and condition in various CNS pathologies. A separate section is devoted to the mechanisms of permeability impairment and the importance of biological markers in diagnosing BBB damage. The authors identify the most informative markers, the study of which in neuroinfections is particularly warranted. Conclusion. Research into the state of the structural components of the brain's neurovascular system in neuroinfections is relevant and aims to develop new biological markers for assessing BBB damage and permeability impairment in a single patient, using both blood and cerebrospinal fluid parameters.
Background. This work is dedicated to the study of the clinical experience with aztreonam. This antibiotic is a reserve drug and is used when a combination of other drugs is ineffective. Objective. To study the experience with aztreonam in complex antibacterial therapy in intensive care units in patients with multiple drug resistance. Material and methods. During the study, the laboratory parameters of 12 patients who received aztreonam were examined. The values of leukocytes, C-reactive protein, neutrophils, lymphocytes and monocytes have been studied. Each parameter was examined at different time points: upon admission, one day before the administration of aztreonam, after 1 day of administration, after 3 days of administration, and after a full course of treatment with aztreonam. Results. A retrospective study of laboratory parameters showed a decrease in the level of leukocytes. The level of band neutrophils remained constant, and the number of segmented neutrophils tended to decrease. There was also an increase in monocytes and a significant increase in the level of lymphocytes. Conclusions. The inclusion of aztreonam in the treatment regimen for patients with multi-drug resistant strains showed changes in laboratory parameters, the clinical course of the disease, and an increased likelihood of a favorable outcome.
Background. The development of hypertriglyceridemia remains an underestimated etiologic factor in the development of acute pancreatitis. This fact should be taken into account in an individualized approach to intensive care. The aim of the study: To identify the characteristics of lipid profiles in patients with severe acute pancreatitis. Material and methods. A total of 85 patients with acute pancreatitis were examined and divided into two groups based on disease severity: group 1 (n=29) with moderate disease severity and group 2 (n=56) with severe disease. Lipid profiles and their dynamics over 14 days were analyzed in both groups. Results. Patients with severe acute pancreatitis were characterized by high triglyceride levels at the time of hospitalization – 6.40 (1.90; 21.11) mmol/l, which decreased during therapy to 2.42 (1.71; 12.43) mmol/l (p=0.036). In patients with moderate disease severity, triglyceride levels fluctuated from 1.67 (1.39; 2.98) mmol/l to 2.53 (1.67; 5.74) mmol/l throughout the study period. Cholesterol and high-density lipoprotein levels were equally low in both groups at all stages of the study, and low-density lipoprotein levels were below 2 mmol/l. A high atherogenic index was found in both groups. Conclusions. Patients with severe acute pancreatitis experience hypertriglyceridemia from day one, with low cholesterol and low high-density lipoprotein levels, but a high atherogenic index. Low-density lipoprotein levels remain within the normal range in severe acute pancreatitis.
This article analyzes both the changes that the healthcare system of Grodno and Grodno district underwent between 1939 and 1941, and the staff of physicians in the reorganized and newly created healthcare institutions of the city and district at that time. According to maximum data, in mid-1940, the number of medical institutions, excluding pharmacies, was 18 in Grodno, and 7 in Grodno district. Available data for the end of 1940 and the first half of 1941 showed that only 17 people out of 103 came from the so-called "old" districts of the USSR. The remaining 86 people, including 10 refugees from central Poland i.e., 83.5% worked as physicians in the territory of the Second Polish Republic. The scientific novelty of this article lies in the fact that the presented data regarding the staff of physicians in Grodno and Grodno district in 1939-1941 are based on the findings of the study. Previously unpublished, these findings are being introduced into academic use for the first time. The theoretical and practical significance of this article lies in its potential for implementation in comprehensive works on the history of medicine in Belarus in general, and in Grodno and Grodno district in particular. It will serve to preserve the memory of those who contributed to the development of our district, not to mention that most of them were killed in the subsequent years of the German occupation.
The paper analyzes the historical roots of the development of medical education in the Belarusian lands. The prehistory of university education in medicine is considered. The historical facts that formed the basis for the traditions and innovations of modern medical education in Belarus as well as the role of the city of Grodno are demonstrated. The 250-year history of the origins of medical education in the Grodno region, its historical primacy, continuity and commonality with medical education of neighboring states have been proven.
Background. In autoimmune ophthalmopathy (AIO), the choroid is involved in the pathological process, which can lead to changes in its thickness, disruption of blood supply and subsequent deterioration of visual function. Optical coherence tomography (OCT) allows for non-invasive assessment of the choroid and quantitative assessment of the choroidal thickness. Objective. To assess choroidal thickness in patients with autoimmune ophthalmopathy using macula OCT and to determine its diagnostic value as a possible marker of inflammatory activity. Material and methods. The study included patients with confirmed AIO and controls. Choroidal thickness was measured in the subfoveal and parafoveal segments using OCT. Statistical analysis was conducted to evaluate intergroup differences and assess the diagnostic performance of the method. Results. Patients with AIO showed a statistically significant increase in choroidal thickness in all studied areas compared to the control group. The measurements demonstrated high sensitivity and specificity, which confirms the diagnostic value of this parameter. Conclusions. Macula OCT provides standardized and quantitative analysis of choroidal thickness, including subfoveal and parafoveal segments, which makes the method effective for dynamic monitoring of the choroidal state in patients with AIO. Choroidal thickness indices can be considered as potential markers of inflammatory activity.
This article presents a clinical case of favorable outcome in a pregnant woman with congenital heart disease, multiple cardiac surgeries, placenta previa and placenta increta. The team of authors emphasizes the importance of interdisciplinary approach and coordinated work of a team of specialists in critical situations, which allows to achieve successful results even with extremely unfavorable prognosis.
Background. Optimization of treatment of tibia fractures remains a complex medical and social problem. Unsatisfactory treatment results (up to 25%) and a high percentage of disability among patients with tibia fractures (up to 30%) stimulate the search for new methods and ways to stimulate bone regeneration. Study objective. To evaluate the effectiveness of complex conservative treatment of patients with closed diaphyseal fractures of the tibia using hyperbaric oxygen therapy (HBOT) and an antioxidant (cytoflavin). Material and methods. A total of 110 patients with closed diaphyseal fractures of the tibia were examined. All patients were divided into 2 study groups: group 1 (comparison group) included 45 people who received standard treatment in the early postoperative period; group 2 (main group) included 65 people whose standard treatment regimen was supplemented with a complex of antioxidant therapy and HBOT. Biochemical blood analysis, inflammatoryintoxication syndrome (procalcitonin, CRP), total antioxidant activity (TAA), and reparative bone tissue regeneration (BALP, P1NP, osteocalcin, phosphorus and calcium ions) were assessed in all patients before treatment, as well as on days 1-2, 5-7 and 15 after surgical treatment. The intensity of pain was assessed using a 10-point visual analogue scale, and the long-term results of treatment were assessed six months after treatment using the Luboschitz-Mattis-Schwartzberg and Johner-Wruhs scales. Results. As criteria for the severity of the inflammatory-intoxication syndrome in patients with closed diaphyseal fractures of the tibia, the threshold levels of CRP and procalcitonin in the blood serum were established – 0.55 ng/ml and 5.6 mg/l, respectively, the excess of which is associated with the development of inflammatory-intoxication syndrome of moderate severity. As criteria for the rate of reparative processes in bone tissue, the threshold values of the venous blood TAA index (1.2 μmol/l) as well as the threshold levels of osteocalcin and BALP (7.8 ng/ml and 45.3 ng/ml, respectively) were established, pathological deviation from which is associated with impaired osteogenesis. The results of the assessment of the clinical effectiveness of postoperative treatment of patients with closed fractures of the tibia using metabolic therapy based on point scales indicate the advantage of the proposed complex metabolic treatment. Conclusions. Complex metabolic therapy including HBOT and administration of cytoflavin demonstrated high clinical efficacy, which allows reducing the length of hospital stay and the number of postoperative complications, including 66.2% of patients with positive results according to the criteria of severity of inflammatory-intoxication syndrome and the rate of reparative processes in bone tissue.
Physical activity positively influences physiological, psychological, and social well-being. However, in the presence of unfavorable predisposing factors, physical activity increases the risk of injury and disease development, which is associated with increased stress on both the musculoskeletal system and various physiological systems of the body. This article explores the historical evolution of orthopedic and traumatology methods in rendering the medical care for athletes, identifying key challenges and potential solutions.
