On September 29, 2023, a meeting of the interdisciplinary expert council “Cognitive health of a comorbid patient” was held in Vladikavkaz. To reduce the social and economic burden of cognitive impairment, which is increasingly being detected in comorbid patients in the Russian Federation, it is necessary to introduce socially significant initiatives for the timely diagnosis and prevention of these diseases, as well as update modern approaches to treatment, taking into account their multifactorial pathogenesis and the risk of complications. Based on the results of scientific reports and discussions held during the expert council, experts made decisions on a further plan within the framework of socially significant initiatives for the prevention of obesity.

AIM:To clarify the role of the uremic toxin indoxyl sulfate (IS) and inflammation in the development of vascular calcification and cardiovascular complications in chronic kidney disease (CKD).MATERIALS AND METHODS:One hundred fifteen patients aged 25 to 68 years with CKD stage C3-C5D were examined. Serum concentrations of IS, interleukin 6 (IL-6), tumor necrosis factor (TNF-α), troponin I, parathyroid hormone were determined by enzyme immunoassay using kits from BluGene biotech (Shanghai, China), Cloud-Clone Corp. (USA), ELISA Kit (Biomedica, Austria).RESULTS:An increase in the serum concentration of IS, IL-6, TNF-α was revealed, which was significantly associated with a deterioration in renal function and changes in the morphological and functional parameters of the heart and aorta.CONCLUSION:High concentrations of IS, IL-6, TNF-α, which are closely associated with an increase in renal failure and cardiovascular complications, indicate their significant role in vascular calcification, which underlies the damage to the cardiovascular system in CKD.

Background . Vascular calcification underlies cardiovascular complications, which remain the leading cause of high mortality in chronic kidney disease (CKD). Uremic toxins, including the advanced glycation end products, play a significant role in the formation of this process. The Aim of the study is to clarify the role of the advanced glycation end products (AGEs) and inflammationproducts in the processes of vascular calcification at different stages of CKD. Patients and Methods. 105 patients aged 18 to 66 years at different stages of CKD C1-C5D were examined, 75 of which were caused by diabetic nephropathy (DN), 30 by other nosological forms. Serum concentrations of AGEs, IL6, TNF-α, troponin I, parathyroid hormone (PTH) were determined by enzyme immunoassay (ELISA). To study the AGEs concentration, the serum was separated by centrifugation (in Eppendorf tubes). The samples were stored at – 70 °C. The left ventricular myocardial mass index (LVMI) was determined. Left ventricular hypertrophy (LVH) was diagnosed with LVH>115 g/m 2 for men and >95 g/m 2 for women. The peak systolic velocity of blood flow in the aortic arch (Vps) was studied by duplex scanning using the Doppler effect. Results . A significant increase in serum phosphorus concentration (p < 0.05) and PTH (p< 0.01) was revealed as the glomerular filtration rate decreased. An increase in the concentration of AGEs, IL6 and TNF-α was found at all stages of CKD, most pronounced at the later stages – C4-C5D ((p< 0.01, p< 0.05, p<0.05, respectively). Pronounced changes in LVMI and Vps were associated with high levels of AGEs, IL6 and TNF-α. CONCLUSION. An increase in the level of glycation end products and inflammatory factors directly and reliably correlated with the severity of uremia and the severity of morphofunctional changes in the heart and aorta, which confirms their significant role in the development of cardiovascular complications in CKD. Keywords: advanced glycation end products, inflammation, vascular calcification, chronic kidney disease>˂0.05, respectively). Pronounced changes in LVMI and Vps were associated with high levels of AGEs, IL6 and TNF-α. Conclusion . An increase in the level of glycation end products and inflammatory factors directly and reliably correlated with the severity of uremia and the severity of morphofunctional changes in the heart and aorta, which confirms their significant role in the development of cardiovascular complications in CKD.

Mesenteric lipomas are very rare. They are asymptomatic in most cases, but some patients can develop certain complications such as small bowel volvulus and acute small bowel obstruction. We report a 78-year-old patient with giant mesenteric lipoma complicated by jejunum volvulus and acute small bowel obstruction. The patient underwent laparotomy, en-bloc resection of small bowel, mesentery and lipoma followed by side-to-side anastomosis.

Aim. To clarify the mechanisms of the effect of osteoprotegerin (OPG) and sclerostin on vascular calcification and the state of the cardiovascular system in chronic kidney disease (CKD). Materials and methods. A total of 110 patients aged 18 to 65 years with CKD stages 3-5D were examined. OPG, sclerostin, intact parathyroid hormone, and serum troponin I were determined using the commercial "Enzyme-linked Immunosorbent Assay Kit for Sclerostin" from Cloude-Clone Corp. (USA) by enzyme-linked immunosorbent assay. Results. An increase in sclerostin and OPG levels was revealed, which significantly correlated with a decrease in glomerular filtration rate, as well as an increase in left ventricle myocardial mass index and peak systolic blood flow in the aortic arch. Conclusion. Changes in the regulation of bone-mineral metabolism, in which the proteins inhibitors of bone metabolism, OPG and sclerostin, as well as the interactive interaction between the vascular and skeletal systems, play a decisive role in the development of lesions of the cardiovascular system caused by vascular calcification in CKD.

Objective. To study the nutritional status of a patient with a complicated course of cholelithiasis and pancreatitis. Materials and methods. A clinical case of a complicated course of cholelithiasis. Methods: clinical, laboratory and instrumental (biochemical blood analysis, ultrasound examination of abdominal organs, esophagogastroduodenoscopy, endoscopic ultrasound, computed tomography of abdominal organs). Results. Based on the data of the clinic, laboratory and instrumental studies, surgical complications of the course of cholelithiasis in the patient were identified (choledocholithiasis, acute destructive pancreatitis with the development of an abscess of the subhepatic space on its background, destructive cholecystitis). Conclusions. Lifestyle modification and timely cholecystectomy would help to avoid the development and complicated course of cholelithiasis.

Splenic metastases are a rare finding and usually associated with advanced cancer. At the same time, isolated splenic metastases are an exception. The authors report a 62-year-old woman with isolated splenic metastasis from colon carcinoma in 28 months after surgery. Splenectomy was successfully performed.

BACKGROUND. The influence of female sex hormones on the regulation of the processes of formation and resorption of bone tissue, as well as the effect of excess or deficiency of sex hormones on renal function is associated with the development of cardiovascular complications in patients at different stages of chronic kidney disease. THE AIM : to study the relationship between estradiol deficiency and excess FSH content with disorders of mineral and bone metabolism and cardiovascular complications in postmenopausal women on hemodialysis. PATIENTS AND METHODS. 119 women from 34 to 57 years old on hemodialysis were examined. The concentration of follicle-stimulating hormone (FSH) and estradiol2, sclerostin, and fibroblast growth factor 23 (FGF-23) was determined using a sandwich-variant solid-phase ELISA on a «Multiscan EX analyzer» («ThermoFisher Scientific Inc.», Finland) with kits of «Alkor-Bio Company» (Russian Federation) and sets of "sandwich" type manufactured by Cloud-Clone Corp., USA. Echocardiography was performed using an «ALOKA 4000 Aplio» (Toshiba, Japan) in Doppler mode. Determined the left ventricular ejection fraction (LVEF), peak systolic velocity in the aortic arch (Vps – peak systolic velocity); LV myocardial mass index (LVMI). Left ventricular hypertrophy (LVH) was defined with LVMI greater than 95 g /m 2 in women. RESULTS. There was a direct correlation between high levels of FSH and high levels of sclerostin, FSH, and FGF23, an inverse correlation between low levels of estradiol2 and sclerostin, estradiol2 and FGF23, expressed in groups of patients with more severe changes in LVMI and Vps. CONCLUSION. In women on hemodialysis, bone mineral and cardiovascular abnormalities are associated with both renal failure proper and changes in the system of female sex hormones. A decrease in estradiol levels causes an increase in the nephrotoxic FSH and contributes to the excessive synthesis of sclerostin, a key factor in bone-mineral and cardiovascular complications in CKD.

On September 30, 2022, a meeting of the interdisciplinary expert council “Prevention and treatment of obesity. How to Achieve a Healthy Metabolic Balance. To reduce the social and economic burden of obesity and its consequences in the Russian Federation, it is necessary to introduce socially significant initiatives to prevent obesity and increase its detection rate, as well as to update modern approaches to the treatment of this chronic disease, taking into account its multifactorial pathogenesis, comorbidity, risk of complications and patient disability. Based on the results of the scientific reports and discussions held during the expert council, the experts made decisions on a further plan within the framework of socially significant initiatives for the prevention of obesity

Objective: to study the causes of pancreatitis. Materials and methods: a clinical case of acute pancreatitis during the treatment of ulcerative colitis with 5-aminosalicylic acid-containing drugs. Methods: clinical, laboratory and instrumental (biochemical blood analysis, standard coprological examination, Ultrasound examination of the abdominal cavity, Esophagogastroduodenoscopy). Results: based on the data of the clinic, laboratory and instrumental studies, a diagnosis was made: drug-induced pancreatitis associated with mesalazine intake. Ulcerative colitis, total form, high degree of activity. Duodenal ulcer disease associated with Helicobacter pylori, unstable remission. Erosive bulbitis. The indicated therapy with polyenzyme drugs, proton pump inhibitors, antispasmodics, and glucocorticosteroids resulted in the resolution of clinical manifestations and the normalization of altered laboratory parameters. Conclusions: the use of 5-aminosalicylic acid preparations for the treatment of ulcerative colitis may be associated with the development of pancreatitis, which must be taken into account in clinical practice.

Федеральное государственное бюджетное образовательное учреждение высшего образования «Северо-Осетинская государственная медицинская академия»

The article is devoted to one of the most important problems in modern gastroenterology a violation of nutritional status and glycaemia in chronic pancreatitis.

BACKGROUND. Cardiovascular complications caused by vascular calcification in chronic kidney disease (CKD) are closely related to disorders of bone and mineral metabolism, the mechanisms of which require further study.THE AIM: to clarify the role of the regulatory proteins of bone metabolism of sclerostin and osteoprotegerin in the processes of vascular calcification and the development of cardiovascular complications in CKD.PATIENTS AND METHODS. 110 patients with stage 3-5D CKD (67 men) were examined. Median age is 47.0 (23.0-68.0) years. Osteoprotegerin (OPG), sclerostin, intact parathyroid hormone (IPTG), troponin I in blood serum were determined using commercial kits "Enzyme-linked Immunosorbent Assay Kit for Sclerostin" ("Cloud-Clone Corp.", USA) and commercial kits "ELISA kit" ("Biomedica" (Austria) by enzyme immunoassay (ELISA). Echocardiography with Dopplerography was performed on the device "ALOKA 4000" ("Toshiba", Japan). The left ventricular myocardial mass index (LVMI) and peak systolic blood flow velocity in the aortic arch (Vps, peak systolic velocity) were determined to quantify hemodynamic changes indirectly indicating the state of the aortic vascular wall.RESULTS. Analysis of the ratios of the calculated glomerular filtration rate (EGFR), IMLJ, Vps, OPG, and sclerostin showed that a decrease in excretory kidney function is accompanied by an increase in the concentrations of OPG and sclerostin in the blood serum. At the same time, there is an increase in IMLJ and Vps. During the correlation analysis, it was shown that the level of OPG was positively correlated with the level of sclerostin and negatively with the level of iPTG.CONCLUSION. In our study, we obtained data confirming the interactive interaction between the vascular and bone systems. Morphogenetic proteins-inhibitors of bone metabolism (sclerostin and OPG) play a significant role in the defeat of the cardiovascular system in patients with CKD, as they promotes the development of vascular calcification.

In chronic kidney disease (CKD), progressive decline in kidney function leads to disorders of mineral metabolism, which are usually called secondary hyperparathyroidism. An increase in the serum concentration of the parathyroid hormone is associ­ated with a decrease in the level of calcium and calcitriol and/or an increase in the level of fibroblast growth factor-23 and inorganic phosphate in serum. CKD-related disorders of mineral and bone metabolism are associated with other metabolic disorders, such as acidosis, protein-energy wasting, inflammation, and accumulation of uremic toxins. This contributes to vascular calcification, which is a consequence of an imbalance between numerous inhibitors and promoters of soft tissue min­eralization. Vascular calcification is a degenerative process characterized by the accumulation of calcium and phosphate salts in the artery wall. This is observed in almost all vascular areas and can develop in the media, intima, or both vascular layers of the arteries. Calcification of the intima usually occurs due to atherosclerosis and may be responsible for coronary ischemic events. Conversely, media calcification is non-exclusive and predominantly develops along elastic fibers. As a result, media calcification increases vascular stiffness, aortic pulse wave velocity, systolic and pulse blood pressure, contributing to the de­velopment of left ventricular hypertrophy and heart failure. This review examines the current understanding of the mechanisms that lead to the development of vascular calcification in CKD. The participation of factors such as inflammation, age glycation end products, indoxyl sulfate, and others in calcification processes is discussed. Promising therapeutic goals associated with a new understanding of the mechanisms of cardiovascular calcification in CKD are identified.

The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (European Society of Urogenital Radiology (ESUR)) updated its 2011 guidelines for the prevention of post-contrast acute kidney injury (PC-AKI). The recommendations are based on literature review data. The updated guidelines will be presented in two parts: Part 1 are discussed clarification of terminology (in particular differences between PC-AKI and contrast-induced nephropathy), the best ways to estimate glomerular filtration rate (eGFR). There were refined risk factors of PC-AKI, including by intravenous and intra-arterial routes of administration of the contrast agent. The key points of the updated recommendations are: 1. PC-AKI is the preferred term to characterize the impairment of renal function after the administration of a contrast agent; 2. PC-AKI has many causes for development; 3.Risk of development of AKI with intravascular injection of a contrast agent, overestimated; 4. Important risk factors for PC-AKI are chronic kidney disease and dehydration.

Current foreign and Russian literature for sepsis epidemiology is reviewed. There is advanced incidence of sepsis in developing countries among young people as a rule. Absent high-quality epidemiological studies lead to overdiagnosis of sepsis and increased morbidity. National and territorial screening and diagnostic programs for sepsis became possible with introduction of new recommendations 'Sepsis-3'. Thus, there is a possibility to systematize regular epidemiological studies devoted to sepsis.

The article presents the results of a questionnaire survey of 197 patients who received inpatient treatment at the Vladikavkaz Junction Station Hospital of Russian Railways JSC. The questionnaire included 26 questions structured according to the levels of work and reflecting the parameters of non-medical expectations of patients. 85 patients of the surgical profile were included in the group I, and 112 patients of the therapeutic profile were included in the group II. The result: the group I demonstrated significantly lower rates of patient satisfaction with the level of social and living conditions when receiving medical care and regarding the compliance with the patients' rights. The average satisfaction rates of patients in the groups were 0.92±0.02 and 0.98±0.02, which generally characterizes the level of social efficiency of the hospital as high. The measures of an educational, economic, disciplinary and scientific-public nature were introduced at the hospital to improve the level of responsiveness of the health system. A structured approach to the organization of population studies among individual groups of patients allows identifying hidden defects in the system of ensuring non-medical expectations of the population and organizing their targeted elimination.

The review, presented in chronological order the stages of formation of the modern definition of sepsis syndrome, since the recommendations of the conciliation conference ACCP/SCCM (1991), the experience of the practical use of which has been extensively critically assessed in future studies. As a result, it formed a strong opinion that the global challenge of early diagnosis of sepsis, under the previously proposed definitive categories have not been solved, moreover, in the scientific community formed a firm belief in the need to make fundamental changes in the definition of the term 'sepsis'. As a result, in 2016 the scientific community were presented the recommendations of the working group 'Sepsis-3', in which sepsis is defined as life-threatening organ dysfunction due to dysregulated response to infection, and fundamentally distinguish them from the former, is a laconic definitions and availability of diagnostic criteria. National expert community to analyze, discuss and define the field of clinical testing 'Sepsis-3' in the Russian Federation.