BACKGROUND. Currently, the treatment of patients who have had coronavirus disease (COVID-19) and have not fully recovered remains an actual issue for practicing physicians. Bone mineral density (BMD) impairment in patients with lung injury in the post-COVID period remains poorly understood. OBJECTIVE. To investigate the bone mineral metabolism disorders in patients with lung injury in the post-COVID period based on chest computed tomography (CT) data. MATERIALS AND METHODS. Densitometry was performed with the use of K-Pacs program. These results were compared with the results of osteoporosis diagnosis based on the standardized program 3D QCT. The dynamics of the chest CT of 21 patients with lung injury in the post-COVID period analyzed retrospectively. Monitoring of the vertebrae structure (Th12, L1-L2) was carried out according to the lowest values of densitometry indicators (mean, minimum and maximum BMD) on axial chest CT slices. RESULTS AND DISCUSSION. Among patients with lung injury in the post-COVID period predominated persons over 50 years of age. In the studied patients, the average BMD value at the beginning of the observation was below normal (148.9±13.2) HU. In 8 (38.1 %) of patients, the average BMD value was normal, in 9 (42.9 %) it corresponded to osteopenia and in 4 (19.0 %) to osteoporosis. After a year of observation, there was a significant decrease in the average BMD value from (148.9±13.2) HU to (129.8±10.9) HU (p<0.01), and the number of patients with osteoporosis doubled. The obtained data indicate that in the absence of positive dynamics of the pathological process in the lungs, there is a progression of metabolic disorders of the vertebrae in patients with lung injury in the post-COVID period. CONCLUSIONS. In patients with post-COVID syndrome during a year of observation and the absence of positive dynamics of the pathological process in the lungs, it is necessary to use drug therapy for bone mineral metabolism.
ABSTRACT. An asymptomatic 9-year-old girl was found to have a destructive formation in the upper lobe of the left lung. Taking into account the localization of the pathological process, its radiological characteristics and epidemiological risks, a preliminary diagnosis of pulmonary tuberculosis was established, although GeneXpert in sputum was negative 3 times. In this regard, the patient received standard antituberculosis chemotherapy for 6 months in accordance with current clinical protocols. However, against the background of the treatment, not only no positive dynamics were achieved, but on the contrary, there was a progression of destructive changes in the lung tissue, which was manifested by an increase in the decay cavity and structural restructuring of the affected lobe. Taking into account the localized nature of the lesion, the lack of effect from conservative treatment, and with the aim of final verification of the diagnosis, a decision was made to carry out surgical intervention (upper VATS-lobectomy on the left) for both therapeutic and diagnostic purposes. The contents of the focus were sent for microbiological examination: GeneXpert was negative, cultured on liquid and dense medium – no growth of Mycobacterium tuberculosis was detected. Histologically: lobar emphysema, complicated by cryptococcosis (cryptococcoma) in association with mycobacterial infection (probably mycobacteriosis), of long-term development. The presented clinical case demonstrates the difficulty of differential diagnosis of localized destructive lung lesions in children in the absence of clinical symptoms. The negative results of multiple microbiological and molecular genetic studies on M. tuberculosis combined with the progression of morphological changes in lung tissue against the background of standard anti-tuberculosis therapy indicated the non-tuberculous nature of the pathological process. Surgical intervention followed by histopathological examination of the resected lung tissue became the decisive stage of the final diagnostic verification and made it possible to determine further treatment tactics. This case emphasizes the expediency of timely application of surgical methods in children with localized chronic destructive lung lesions in the absence of effect from conservative treatment.
ABSTRACT. This article presents a comprehensive analysis of the current scientific literature on mucopolysaccharidoses (MPS) ‒ a heterogeneous group of rare inherited lysosomal storage disorders. It highlights current data from epidemiological studies and presents modern views on the etiopathogenesis and clinical polymorphism of various types of MPS. Particular attention is paid to the systematization of general clinical markers, which allows the practicing physician to suspect the pathology in a timely manner and perform differential diagnosis with similar conditions. The integral links between types of MPS and specific lesions of the cardiovascular system are analyzed in detail. The authors have systematized the most common cardiac manifestations: acquired valvular defects (mitral and aortic valve insufficiency and stenosis), arrhythmias and conduction disturbances, cardiomyopathies, as well as the development of progressive heart failure. An algorithm for modern laboratory and instrumental diagnostics has been established, based on a combination of imaging methods and mandatory verification of the diagnosis through enzymatic and molecular-genetic testing. The evolution of therapeutic strategies for MPS is reviewed, including the efficacy of enzyme replacement therapy, hematopoietic stem cell transplantation, and promising directions in gene engineering.
BACKGROUND. Epidemiological data and disease registries are an important source of evidence for clinical practice and healthcare delivery, especially in the absence of randomized controlled trials. Most of what we know about pulmonary arterial hypertension today comes from observational studies conducted within national and/or international disease registries. OBJECTIVE. To critically review the role of epidemiological data, disease registries, and their cyclical interaction in the evolution of the pulmonary hypertension classification system. MATERIALS AND METHODS. The work is based on the results of observational studies. We used epidemiological and natural history register data to estimate the nonfatal and fatal burden of pulmonary hypertension in six countries and territories from 1995 to 2023. Standard approaches were used to model the global significance of the disease. We focused on pulmonary hypertension groups 2-5 and excluded group 1, i. e. pulmonary arterial hypertension. RESULTS AND DISCUSSION. The development of the classification of pulmonary hypertension is analyzed – from the division into primary and secondary to the current 5-group system of the World Health Organization (2013). An in-depth analysis was performed and six key epidemiological parallels were identified (in particular, the impact of epidemiological rarity or, conversely, prevalence on the classification grouping) that reflect the evolution of the understanding of this syndrome. CONCLUSIONS. The prospects for further development of registries and classification of pulmonary hypertension in the era of “big data” are outlined. It is indicated that the integration of information sources can provide a deeper understanding of the hemodynamic component of the risk group and expand the diagnostics of chronic thromboembolic pulmonary hypertension. The inextricable link between epidemiological data and classification changes is proven.
ABSTRACT. Infusion therapy in critical conditions, while technically simple, requires a complex approach to select the optimal type and volume of fluid. Personalized therapy is considered a new strategy for resuscitating seriously ill patients, especially those with sepsis and shock. This strategy involves the individual selection of volume, composition, and infusion rate of fluids based on the patient's clinical status. It is important to differentiate between fluid replacement and volume replacement, as different indications require different strategies. Incorrect fluid selection can harm half of the patients, and dynamic indicators must be used to assess responsiveness. The integration of artificial intelligence for analyzing electrocardiograms has potential in monitoring cardiac disorders, although there is currently no evidence indicating the benefit of colloid solutions over crystalloids in reducing mortality. Personalized therapy should rely on the concept of “fluid management”, which includes 4 Ds (drug, dose, duration, deescalation) and 4 ROSE components (resuscitation, optimization, stabilization, evacuation). These approaches can help reduce morbidity and improve treatment outcomes. Future studies should assess infusion therapy's effectiveness and safety in diverse patient groups, considering individual factors and clinical context.
BACKGROUND. Laryngeal tuberculosis (LTB) is a rare but clinically significant form of extrapulmonary tuberculosis that is often associated with diagnostic challenges due to the nonspecific nature of its clinical manifestations and the considerable polymorphism of its endoscopic appearance. OBJECTIVE. To summarize current scientific evidence regarding the epidemiology, clinical manifestations, diagnostic features, and differential diagnosis of LTB. MATERIALS AND METHODS. Object of the study is LTB as a form of extrapulmonary tuberculosis. A literature search and analysis were conducted using scientific publications indexed in the PubMed, Embase, and Cochrane Library databases. The search included the keywords “laryngeal tuberculosis,” “tuberculosis of the larynx,” “larynx,” “upper airway tuberculosis,” and “extrapulmonary tuberculosis” and covered studies published within the last 10 years. RESULTS. LTB most commonly develops as a result of bronchogenic spread of infection in patients with pulmonary tuberculosis; however, isolated laryngeal involvement may also occur. The most characteristic clinical manifestations are dysphonia, dysphagia, and odynophagia. Laryngoscopic findings are highly variable and frequently mimic laryngeal malignancies. Diagnostic confirmation requires a comprehensive approach, including laryngoscopy and histological, microbiological, and molecular genetic investigations. Particular diagnostic challenges arise in isolated paucibacillary forms of the disease. CONCLUSIONS. LTB should be included in the differential diagnostic workup of patients with persistent laryngeal disorders. Timely comprehensive diagnosis and early initiation of antimycobacterial therapy can prevent the development of irreversible structural and functional changes of the larynx.
BACKGROUND. The paper presents an analysis of literature data on the glutathione-dependent enzyme system, the results of the authors' own studies on disorders in it, and the effect of mexidol in experimental pulmonary emphysema. OBJECTIVE. To study the nature of changes in the glutathione-dependent enzyme system of blood in experimental pulmonary emphysema and the possibility of using mexidol as a protector. MATERIALS AND METHODS. Experimental studies were conducted on 45 sexually mature, outbred white rats weighing 180-200 g. Pulmonary emphysema was reproduced by a single intratracheal injection of 0.5 ml of papain solution at doses of 50 and 100 mg/kg of weight. The activity of glutathione reductase, glutathione-S-transferase and glutathione peroxidase was determined in the blood. To assess the possibility of reactivating enzymes of the glutathione system, mexidol was used, which has a wide spectrum of pharmacological action, based on its antioxidant, antihypoxic, and membrane-protective properties. RESULTS AND DISCUSSION. It was established that the development of pulmonary emphysema is accompanied by impaired function of glutathione reductase, glutathione-S-transferase and glutathione peroxidase. It was shown that these changes are not irreversible. Mexidol promotes reactivation of the glutathione-binding enzyme system. CONCLUSIONS. In experimental pulmonary emphysema, the activity of enzymes of glutathione metabolism is disrupted. The dynamics of changes in the blood indicators of the glutathione enzyme system under the influence of mexidol, its metabolic effect indicate the possibility of using this drug as a protector in pulmonary emphysema.
ABSTRACT. Antimicrobial resistance represents a serious global public health problem and poses a major challenge in the management of combat-related injuries during armed conflicts, such as the war of Russia against Ukraine. This paper describes a clinical case of a 32-year-old military patient who sustained combat-related injuries complicated by extensive wound infections caused by multidrug-resistant and pandrug-resistant bacteria and was successfully treated with combination antibacterial therapy including azithromycin and meropenem. The isolation of a pandrug-resistant Pseudomonas aeruginosa strain highlighted the severity of the clinical condition and the limited availability of effective therapeutic options. In addition, the high cost of reserve antibiotics and the unavailability of novel antimicrobial agents further complicated the treatment of these infections. This clinical case demonstrates the effectiveness of combination therapy with azithromycin (500 mg three times daily) and meropenem (2 g three times daily). Treatment administered over 37 days (27 days of azithromycin and 20 days of meropenem) resulted in clinical improvement and eradication of resistant pathogens. The findings underscore the importance of effective antimicrobial stewardship, strengthened infection prevention and control measures, and the implementation of alternative therapeutic strategies to overcome antimicrobial resistance in the context of combat-related trauma.
BACKGROUND. One of the main pathogens causing ventilator-associated pneumonia is carbapenem-resistant Acinetobacter baumannii. Our study aims to compare the results of treatment of patients with ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii by providing two schemas of antibacterial therapy: colistin + meropenem and cefoperazone-sulbactam + meropenem. The infections caused by carbapenem-resistant A. baumannii represent a huge problem in the treatment of nosocomial infections, because of a high rate of morbidity and mortality among critically ill patients. OBJECTIVE. To compare the efficiency of two arms of final antibacterial therapy, which were based on colistin, cefoperazonesulbactam and meropenem. MATERIALS AND METHODS. The study included 83 patients with ventilator-associated pneumonia caused by carbapenemresistant A. baumannii. The patients were divided into two groups: the observation group received the traditional combination of colistin + meropenem; the study group received combination of cefoperazone-sulbactam + meropenem. RESULTS AND DISCUSSION. Among the patients with ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii the 28-day mortality level in the study group was 34.67 % lower, than in the observation group. Clinical recovery in the study group on days 14 and 28 was documented more frequently than in the observation group. Microbiologic failure in the cefoperazone-sulbactam group was registered 20.3 % less often than in the group using the tradition combination of colistin + meropenem. The 28-day RIFLE score-based kidney injury in the study group was significantly lower, than in the observation group. It was estimated, that colistin-based combination antibacterial therapy was a risk factor for all-cause mortality within 28 days. In contrast, cefoperazone-sulbactam-based combination antimicrobial therapy was associated with higher survival level on day 28. CONCLUSION. Cefoperazone-sulbactam + meropenem combination has more advantages in comparison with colistin + meropenem combination among patients with ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii.
ABSTRACT. The article provides a systematic review of lung damage associated with the use of electronic cigarettes or vaping products (EVALI – E-cigarette and Vaping use-Associated Lung Injury). Diagnostic and therapeutic algorithms for these patients are proposed. Attention is focused on the problem of timely detection of EVALI, in particular the difficulties of differential diagnosis with viral infections and other diseases. The pathophysiological mechanisms and histopathological manifestations of EVALI are discussed, and the characteristics of clinical manifestations are analysed. Current EVALI treatment protocols are reviewed and areas for further research needed to improve the management of patients with EVALI are identified.
BACKGROUND. Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by hyperglycemia, insulin resistance, and the development of multiple complications. In addition to standard pharmacotherapy, increasing attention in recent years has been paid to the role of micronutrients and vitamins in modulating metabolic disturbances associated with T2DM. This article summarizes current evidence from systematic reviews, meta-analyses, and randomized controlled trials regarding the effects of magnesium, zinc, chromium, selenium, and vitamins D₃, C, and B₁₂ on glycemic control, insulin resistance, and related metabolic parameters in patients with T2DM. The findings indicate that the effectiveness of nutritional supplementation is heterogeneous and largely dependent on baseline deficiency status, dosage, duration of intervention, and patient characteristics. Particular emphasis is placed on the clinically significant association between metformin therapy and vitamin B₁₂ deficiency. Overall, the available evidence supports the need for an individualized approach to the assessment of nutritional status and highlights the necessity for further high-quality studies. OBJECTIVE. To analyze and synthesize current scientific evidence on the effects of micronutrients and vitamins on hyperglycemia and other metabolic parameters in patients with T2DM, and to assess the clinical relevance of their supplementation. MATERIALS AND METHODS. The object of the study is published systematic reviews, meta-analyses, and randomized controlled trials investigating the effects of magnesium, zinc, chromium, selenium, and vitamins D₃, C, and B₁₂ on glycemic control and metabolic status in patients with T2DM. RESULTS AND DISCUSSION. Analysis of the available literature indicates that vitamin D₃ supplementation is associated with a modest but statistically significant reduction in fasting plasma glucose, glycated hemoglobin (HbA1c), and HOMA-IR index, particularly in patients with vitamin D deficiency, obesity, or elevated baseline HbA1c levels. Oral magnesium supplementation demonstrates dose- and time-dependent effects and may contribute to improved long-term glycemic control, primarily through reductions in HbA1c during prolonged administration. High-dose and long-term vitamin C supplementation is associated with decreases in fasting glucose, fasting insulin, and HbA1c; however, the overall quality of evidence remains low. Data regarding zinc, chromium, and selenium are inconsistent. Zinc plays an important biological role in insulin synthesis and secretion, yet routine supplementation is not supported by sufficient clinical evidence. The effects of chromium and selenium remain controversial. Long-term metformin therapy is consistently associated with an increased risk of vitamin B₁₂ deficiency, which may lead to clinically significant hematological and neurological complications and therefore requires regular monitoring. CONCLUSIONS. Micronutrients and vitamins may modulate glycemic control and metabolic processes in T2DM; however, the strength of evidence varies substantially among different nutrients. The most robust evidence is available for vitamin D₃, magnesium, and vitamin C, with observed effects depending on baseline deficiency, dosage, and duration of supplementation. Evidence regarding zinc, chromium, and selenium remains inconclusive and does not support their routine use as therapeutic agents. Metformin-induced vitamin B₁₂ deficiency represents a clinically significant issue that requires systematic screening and timely correction. Further large-scale, well-designed randomized controlled trials are needed to establish clear clinical recommendations.
BACKGROUND. Literature analysis indicates the relevance of the problem of increasing the effectiveness of tuberculosis (TB) treatment in Ukraine under martial law. A comprehensive assessment of various TB risk factors is an important component not only for its early detection and prevention, but also for the most effective treatment. OBJECTIVE. To assess the impact of TB risk factors on the effectiveness of its treatment during the war in Ukraine. MATERIALS AND METHODS. Data from a survey of 49 TB doctors on the assessment of the impact of war-related TB risk factors on the effectiveness of its treatment. Mathematical and statistical methods were used to evaluate the results. RESULTS AND DISCUSSION. During the war, the importance of socio-economic and organizational factors increased, and many new war-related factors emerged. Among them, the following factors have the greatest impact on the effectiveness of treatment: organizational factors – worsening access to TB diagnostics and treatment, imbalance between the increased need for health care and the decrease in its capacity, damage to medical infrastructure, difficulty in accessing basic medical care, incomplete staffing, interruptions in the provision of medical care, deterioration in the supply of medicines and medical products; socio-economic – deterioration of living conditions, significant crowds of people, internal displacement of the population, homelessness, deterioration of material and financial support, financial and economic difficulties in the country, destruction of critical infrastructure, deterioration of sanitary conditions; medical – increase in endocrine, cerebrovascular, gastrointestinal diseases, coronary heart disease, arterial hypertension, HIV infection and psycho-emotional disorders, exacerbation of chronic diseases, decrease in HIV-infected people receiving antiretroviral therapy. CONCLUSIONS. To ensure the success of TB treatment and prevention during and after war, it is necessary to adapt anti-TB interventions to the impact of war-related TB risk factors and ensure monitoring of trigger factors, which will help improve the provision of care to specific population groups and improve the TB assessment system to identify patients at risk of treatment failure.
BACKGROUND. 39.5 % of civilians with drug-resistant tuberculosis (TB) of the lungs have decreased densitometric indicators of the vertebrae before the start of treatment. There is currently no data on impaired bone mineral density (BMD) in military patients with pulmonary TB who were in the Russian captivity for a long time (2-3 years). OBJECTIVE. To trace bone mineral metabolism disorders in soldiers of the Armed Forces of Ukraine (AFU) with pulmonary TB who were returned from Russian captivity, based on chest computed tomography (CT) data and compared with the data in civilians with pulmonary TB. MATERIALS AND METHODS. Densitometry was performed using the K-Pacs program. The results were compared with the results of osteoporosis diagnosis using a standardized 3D QCT program. CT of the chest organs of 37 patients – civilians and military patients with pulmonary TB, in whom monitoring of the vertebrae structure (Th12, L1-L2) was carried out for the lowest densitometric values indicators (average, minimum and maximum BMD) on axial CT sections were analyzed in dynamics. The first group consisted of 23 civilian men with pulmonary TB. The second group consisted of 14 military men with pulmonary TB who had been returned from Russian captivity. All patients were being treated at the State Institution “National Scientific Center for Phthisiology, Pulmonology and Allergology named after F.G. Yanovsky of the National Academy of Medical Sciences of Ukraine”. RESULTS. In military patients with pulmonary TB who were returned from Russian captivity, the mean BMD value was statistically significantly lower than in civilians with the same pathology (109.4±7.9 vs 155.5±11.2; p <0.01). CONCLUSIONS. 92.9 % of AFU soldiers with pulmonary TB who were returned from Russian captivity have bone pathology: 42.9 % have osteopenia and 50.0 % have osteoporosis. The decrease in BMD in these patients does not depend on the prevalence of the pathological process in the lungs.
ABSTRACT. Lymphangioleiomyomatosis (LAM) is a slowly progressive, low-grade, metastasising neoplasm of women, characterised by infiltration of the lung parenchyma with abnormal smooth muscle-like cells, resulting in cystic lung destruction. The invading cell in LAM arises from an unknown source and harbours mutations in tuberous sclerosis complex (TSC) genes that result in constitutive activation of the mechanistic target of rapamycin (mTOR) pathway, dysregulated cellular proliferation, and a programme of frustrated lymphangiogenesis, culminating in disordered lung remodelling and respiratory failure. Over the past two decades, all facets of LAM basic and clinical science have seen important advances, including improved understanding of molecular mechanisms, novel diagnostic and prognostic biomarkers, effective treatment strategies, and comprehensive clinical practice guidelines. Further research is needed to better understand the natural history of LAM; develop more powerful diagnostic, prognostic, and predictive biomarkers; optimise the use of inhibitors of mTOR complex 1 in the treatment of LAM; and explore novel approaches to the development of remission-inducing therapies. LAM affects women of reproductive age (20-40 years old), is a hormone-dependent disease. Estrogen plays an important role, but sporadic forms or forms that are part of tuberous sclerosis are also observed, when LAM is combined with other manifestations of TSC. At the heart of LAM are mutations of the TSC1 or TSC2 genes, which lead to hyperactivation of the mTOR pathway, i. e., uncontrolled cell growth. The main symptoms of LAM are shortness of breath (at first during physical exertion, then at rest), pneumothorax, cough (with hemorrhagic sputum), chylothorax, chest pain, and with aggressive progression, kidney damage in the form of angiomyolipoma. Diagnosis of LAM involves high-resolution computed tomography of the chest (a typical picture of multiple cysts in all lungs), a test for vascular endothelial growth factor D – VEGF-D (an elevated level is highly specific for LAM), lung biopsy (in doubtful cases), assessment of lung function (spirometry – reduction of DLCO, obstructive type of disorders), examination for tuberous sclerosis, renal angiomyolipomas, lymphatic lesions. Key aspects of LAM treatment: sirolimus (rapamycin), a drug that inhibits mTOR and slows disease progression; bronchodilators, oxygen therapy, pleurodesis for repeated pneumothoraxes; lung transplantation at the terminal stage; exclusion of estrogencontaining drugs (oral contraceptives, hormone replacement therapy). Prognosis: the disease is slowly progressive. Thanks to sirolimus therapy, life expectancy can be 10-20 years or more after diagnosis. In this article, we describe a case of pulmonary LAM complicated by staged bilateral chylothorax in a 43-year-old woman.
BACKGROUND. The development of right heart catheterization has provided doctors with the opportunity to diagnose pulmonary hypertension as a result of multiple diseases, as well as hemodynamic disorders in the small circle of blood circulation in patients with congenital and acquired right heart defects. Assessment of the parameters obtained during right heart catheterization allows monitoring the condition of patients in intensive care units with severe cardiovascular diseases. OBJECTIVE. To review the development of right heart catheterization, which has led to the possibility of conducting physiological studies of cardiovascular dynamics in patients with various diseases, as well as to review current disputes regarding the extension of right heart catheterization up to the pulmonary artery. MATERIALS AND METHODS. Animal experiments for the development of heart catheterization; experiments on humans to measure heart pressure; right heart catheterization and Fick's direct principle; right heart catheterization as a universal tool for hemodynamic research; contributions of various investigators to the development of right heart catheterization are considered. RESULTS AND DISCUSSION. Understanding the history of right heart catheterization allows physicians to better appreciate the current clinical applications and limitations of this important therapeutic modality. It has been demonstrated that a pulmonary artery catheter provides the physician with the advantage of continuous hemodynamic monitoring, which may assist the physician in making optimal therapeutic decisions to prevent right ventricular decompensation. CONCLUSIONS. Right heart catheterization is an important diagnostic tool that assists the physician in diagnosing pulmonary hypertension as a manifestation of a wide range of heart and lung diseases and, in addition, when the catheter is placed proximal to the right atrium (auricle), it provides an important and safe route for drug administration and parenteral nutrition.
ABSTRACT. The article presents a comprehensive analysis of contemporary approaches to the diagnosis of congenital lung malformations and anomalies (CLMAs), which account for 5-18 % of all thoracic organ anomalies. Epidemiological aspects, classification, and morphological features of the most common forms are discussed, including congenital pulmonary airway malformation, pulmonary sequestration, congenital lobar emphysema, bronchogenic cysts, as well as rare anatomical variants such as tracheal bronchus or accessory lung. Attention is drawn to the phenomenon of hybrid lesions that combine characteristics of multiple nosologies. The significance of prenatal diagnostics, particularly ultrasound and MRI, is highlighted as essential for timely detection of pathologies and planning the management of newborns. Considerable attention is given to the genetic factors and pathogenesis of CLMAs, including the role of mutations in the FGF10 and TBX4 genes, as well as associations with primary ciliary dyskinesia. It is shown that malformation development has a polyetiological nature, combining genetic, embryological, and exogenous factors. Clinical manifestations range from asymptomatic cases to severe respiratory failure, and pathognomonic features of individual forms are identified. It is summarized that diagnosis of congenital lung malformations relies on a combination of clinical data, the results of instrumental methods (CT, MRI, bronchoscopy), histological studies, and genetic testing. The findings are crucial for timely selection of optimal therapeutic strategies, prevention of infectious complications, and reduction of the risk of malignant transformation.
ABSTRACT. Mitochondria are organelles surrounded by a double membrane consisting of outer and inner membranes, an intermembrane space, and a matrix. Mitochondria are involved in a variety of biochemical processes: the synthesis of most of the adenosine triphosphate, the synthesis of fatty acids, the formation of intracellular reactive oxygen species, antioxidant control, oxidative phosphorylation, redox regulation, thermogenesis, the regulation of ionic (calcium in particular) homeostasis, participation in various biosynthetic pathways, and many others, that is why mitochondria are considered the center of cellular metabolism. Mitochondria require constant renewal and replacement of their components for proper functioning and undergo continuous processes of fission, fusion, mitophagy, and transport that determine the morphology, quality, quantity, distribution, and function of mitochondria in cells. Pathology associated with mitochondrial dysfunction can be hereditary or acquired. Primary mitochondrial diseases can arise from mutations in mitochondrial and/or nuclear DNA genes encoding electron transport chain proteins. Secondary mitochondrial dysfunction can accompany many hereditary pathological processes unrelated to oxidative phosphorylation, and can be acquired because of adverse environmental influences that can cause oxidative stress. Treatment of mitochondrial diseases is a difficult task, as it is currently practically only symptomatic. Most therapies are aimed either at improving mitochondrial function or at treating the consequences of mitochondrial dysfunction with antioxidants and agents that improve metabolism. Gene therapy and inhibitors of mitochondrial fission are under investigation. The extreme clinical, genetic, and biochemical variability of primary mitochondrial diseases, combined with the small number of patients and the frequent lack of adequate preclinical models, limit the identification of useful clinical outcomes and the development of effective therapies.
BACKGROUND. Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease, the course of which is largely determined by the quality of glycemic control and the development of metabolic and microvascular complications. In recent years, there has been growing interest in the role of trace elements and vitamin D₃ as potential modifiers of the course of the disease. OBJECTIVE. Generalization and critical analysis of current scientific data on the effect of trace elements (zinc, chromium) and vitamin D₃ on hyperglycemia and other clinical indicators in patients with T1DM in order to evaluate their potential role as adjuvant factors of metabolic control. MATERIALS AND METHODS. The object of the study is scientific sources published in recent years (original studies, systematic reviews, meta-analyses and experimental works) dedicated to the study of the role of zinc, chromium and vitamin D₃ in the regulation of carbohydrate metabolism, immune and metabolic processes in patients with T1DM. RESULTS AND DISCUSSION. Zinc is a key trace element in the regulation of synthesis, stabilization and secretion of insulin, as well as in the maintenance of antioxidant protection and immune balance. Zinc deficiency in patients with T1DM is associated with poorer glycemic control, increased oxidative stress, and a higher risk of chronic complications, but convincing evidence for the clinical efficacy of routine use of this trace element is lacking. Chromium may potentially potentiate insulin action and influence glycemic fluctuations, but most of the available evidence is in patients with type 2 diabetes. For the T1DM population, data are limited and conflicting, preventing chromium from being recommended as a standard component of therapy. Vitamin D₃ plays an important role in metabolic control in T1DM: 25(OH)D deficiency is associated with hyperglycemia and worse disease compensation. At the same time, the results of intervention studies regarding the effect of vitamin D₃ on HbA1c level are ambiguous, although some studies have noted a decrease in fasting glucose and insulin requirements. Overall, the evidence base for the use of micronutrients and vitamin D₃ in patients with T1DM remains limited due to small samples, short follow-up, and significant methodological heterogeneity of studies, which makes it difficult to formulate clear clinical recommendations. CONCLUSIONS. The analysis of current scientific data shows that zinc, chromium and vitamin D₃ have the potential to influence glycemic control and other clinical indicators in patients with T1DM. Decreased zinc and vitamin D₃ levels in these patients are associated with poorer glycemic control and metabolic dysregulation, whereas the evidence base for the role of chromium remains limited and controversial. Correction of deficiencies of these nutrients can be considered individually under clinical supervision, and further large-scale randomized trials are necessary to form clear clinical recommendations.
BACKGROUND. Infectious diseases, particularly those caused by Mycobacterium tuberculosis (TB), remain a major global health challenge and impose a substantial burden on society. Melatonin is an endogenous hormone with multiple biological properties. Accumulating evidence indicates that melatonin may play a significant role in the management of infectious diseases, including TB. OBJECTIVE. To improve the effectiveness of pathogenetic treatment in patients with pulmonary TB during the intensive phase by incorporating melatonin, considering its therapeutic properties. MATERIALS AND METHODS. A randomized clinical study enrolled 117 TB patients, including 60 individuals with pulmonary TB, who were divided into two groups of 30 patients each. Group 1 (main) included patients with drug-sensitive pulmonary TB who received standard anti-TB therapy combined with melatonin. Group 2 (control) consisted of patients who received anti-mycobacterial therapy alone. RESULTS AND DISCUSSION. In patients with pulmonary TB, the inclusion of melatonin as part of pathogenetic therapy alongside anti-mycobacterial treatment is accompanied by a significant increase in its serum concentration (from 33.2±1.28 to 41.96±3.95 pg/mL). Melatonin contributed to a statistically significant reduction in hepatic enzymes (ALT and AST), indicating its hepatoprotective and anti-inflammatory effects. The median level of C-reactive protein at the end of the intensive phase was substantially lower in the melatonin-supplemented group. The administration of melatonin was associated with a statistically significant decrease in interleukin-6 level (r=-0.52; p=3.19.10-4) and a tendency toward higher interleukin-10 level, reflecting its modulatory influence on the immune system. The pathogenetic use of melatonin in the complex management of patients with pulmonary TB accelerates radiological regression, which may be attributed to its capacity to modulate immune responses and promote reparative processes within the pulmonary tissue. CONCLUSIONS. Enhanced pathogenetic therapy with adjunctive melatonin during the intensive treatment phase promotes activation of nonspecific immunity and reduces tissue damage resulting from the infectious process. Thus, melatonin increases and mediates the patient’s resistance to mycobacterial infection while attenuating the harm caused by the host inflammatory response.
ABSTRACT. The presented clinical case is of significant practical interest in the context of managing patients with systemic purulent-septic complications on the background of a polymorbid condition and socially determined risk factors. The case involves a total left-sided pleural empyema complicated by the formation of a right breast abscess, likely due to hematogenous dissemination of pathogenic flora. The patient had a history of intravenous psychoactive substance use and was undergoing opioid substitution therapy – a key contextual factor, given the immunosuppressive and metabolically depleting nature of addiction. The diagnostic and therapeutic strategy adhered to the principles of modern thoracic surgery: an early minimally invasive intervention was performed – video-assisted thoracoscopic surgery with pleural cavity decompression and drainage. Special attention is warranted for both intraoperative and postoperative management, which was complicated by the development of severe normocytic anemia, necessitating transfusion therapy in accordance with patient blood management protocols. This case underscores the necessity for a personalized, multidisciplinary approach to the treatment of surgical infections in patients with impaired immune homeostasis, destabilizing social determinants, and elevated risk of infectious complications.
