BACKGROUND: There is convincing evidence of the negative impact of vaping on the respiratory and cardiovascular systems. In addition, it is advisable to evaluate the gastroenterological aspects of smoking electronic cigarettes. AIM: To assess the impact of vaping on the functional state of the gastroesophageal zone in healthy people compared to patients suffering from gastroesophageal reflux disease. MATERIAL AND METHODS: The study included 90 patients, divided into three groups of 30 people. The first group consisted of individuals without gastrointestinal diseases, regularly (more than 12 months) smoking vapes. Patients of the 2nd group suffered from gastroesophageal reflux disease. The 3rd group (control) included healthy individuals without bad habits. Using validated questionnaires, clinical manifestations of reflux syndrome were assessed, daily pH-impedancemetry was performed, and serum gastrin and motilin levels were studied. Statistical processing was performed using the Kruskal-Wallis criterion and the Dunn test. Fisher's exact test was used to compare qualitative features, and the Spearman correlation coefficient was used to assess dependencies. The study established a significance criterion of p 0.05. RESULTS: In the 2nd group, along with symptoms of reflux disease, a low pH level of the esophagus lower third and a high daily number of all types of reflux were recorded. In this group, in comparison with the control group, a low level of motilin in the blood was detected (83.2 [56.9; 99.3] pg/ml and 189.7 [117.6; 362.3] pg/ml, respectively, p=0.001). In the group of vapers, compared with healthy controls, a greater severity of reflux syndrome and an increase in the daily number of acidic (54 [39.5; 71] and 21.5 [18; 28.8], respectively, p=0.001) and weakly acidic (7.5 [4.3; 9.8] and 2 [1; 3], respectively, p=0.001) refluxes were recorded, against the background of a decrease in the pH level in the esophagus (4.7 [4.1; 5.9] and 6.7 [6.2; 6.8], respectively, p=0.001). CONCLUSION: Vaping is accompanied by an increase in the number of gastroesophageal refluxes, probably due to inhibition of the motility of the lower esophageal sphincter and can contribute to the development of gastroesophageal reflux disease.

The article presents a clinical observation of a patient with hereditary hemolytic anemia and cholelithiasis that developed from it. The record of ultrasound of the abdominal, magnetic resonance cholangiopancreatography, and the movement of laboratory parameters are demonstrated. The patient underwent splenectomy with cholecystectomy, the information of the postoperative period are presented. The purpose of the article was to study, using the example of this clinical case, the features of the course of hereditary spherocytosis complicated by cholelithiasis in an adult patient; to assess the feasibility of the presented variant of the tactics of managing patients with this pathology. It is shown that at the present stage, despite the dynamic pace of development, pharmacology does not offer effective therapy, and splenectomy remains the only method for treating hereditary spherocytosis. Removal of the spleen eliminates intrasplenic hemolysis and therefore corrects the anemia. With the development of gallstone disease as a result of hemolysis, splenectomy is performed in combination with cholecystectomy.

The article presents the review of the modern approaches and issues in management of the patients with primary hypothyroidism. To date globally multiple nonclinical and clinical studies designed to improve the substitutional therapy and quality of life of patients with primary hypothyroidism are performed. The objective of the review is to analyze the global studies for last 5 years and the modern literature concerning the new possibilities and approaches to the primary hypothyroidism treatment. To achieve this objective the systematic search in PubMed dataset with these key words using: "primary hypothyroidism treatment", "levothyroxine side effects", "primary hypothyroidism outcome", "new approaches to hypothyroidism therapy", "new formulations of levothyroxine", "hypothyroidism in elderly" for the period from 2018 to 2023 was performed. Based on this analysis the conclusions that the investigation of different disease course features and discovering of new treatment options are necessary despite the apparent simplicity of substitutional therapy were made.

Objective. To evaluate the diagnostic capabilities of the method of studying the voltage (partial pressure) of oxygen (pO2) in urine to characterize the state of the kidneys in COVID-19 infection. Patients and methods. The study is based on the results of continuous prospective (cohort) study organized in 2020-21 on the basis of the Republican Clinical Infectious Diseases Hospital in Izhevsk. The included patients were divided into 3 groups: I – 14 patients with signs of acute kidney injury (AKI), which resolved within the next 7 days (group of patients with AKI), II – 12 people whom AKI was not stopped within 7 days (group of patients with acute kidney disease (AKD)), III – 17 patients of the comparison group (patients without clinical and laboratory signs of AKI). Clinical and laboratory examination of patients, including the study of pO2 in urine, was carried out for 7 days daily. Results. With the development of AKI in COVID-19, a significant (p < 0.001) decrease in pO2 in urine to 47.1 mmHg is observed. Increasing of pO2 in urine by 20% of the minimum value with 95% probability (p < 0.05) may be the predictor of subsequent decreasing in urea and creatinine levels within 72 hours and with the probability of 72% (p < 0.05) – a predictor of AKI resolution. Conclusion. The revealed correlations between the indicators of pO2 in urine with the parameters of the functional state of the kidneys indicate the possibility of their using in the diagnosis, assessment of the severity and dynamics of the condition of patients with AKI during COVID-19. Key words: COVID-19, oxygen tension in urine, acute kidney injury

Abstract. Introduction. Currently, the use of electronic cigarettes is becoming the most popular with and widespread among young people. In Russia, one third of electronic cigarettes consumers are people aged 18 to 29 years. The impact of vaping on various body organs and systems is still understudied now. The aim of our study is to investigate the acid-forming and motor functions of the stomach in people consuming electronic cigarettes. Materials and methods. The study involved 54 people, of which 27 were consumers of electronic cigarettes, all without any diagnosed organic diseases in their digestive systems. The severity of gastroenterological symptoms was assessed using the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire, while motor and acid-forming functions of the stomach were assessed according to pH-impedance measurements. The findings were processed statistically using nonparametric tests with the Microsoft Office Excel 2013 and Statistica 10.0 computer programs. Results and discussions. Vaping participants had significantly more gastrointestinal symptoms according to the Gastrointestinal Symptom Rating Scale as compared to their non-smoking peers. In the group of subjects consuming electronic cigarettes, there was a greater number of pathological gastroesophageal refluxes and increased acidity in the lower esophagus and stomach as compared to the control group. Conclusions. Our findings indicate the adverse effects provided by electronic cigarettes on the functional activity of the upper gastrointestinal tract.

Objective. To characterize the relationship of alleles of single nucleotide genetic polymorphisms in the genes of the hemostasis system and folate cycle with the severity of the course and outcomes of the COVID-19 coronavirus infection. Patients and methods. The study conducted on the basis of the Republican Clinical Infectious Diseases Hospital of Izhevsk in 2020–2021 included 40 patients with COVID-19. The study of alleles of single nucleotide polymorphisms (SNP) of 12 genes encoding factors of the blood coagulation system was performed in patients. Biological analysis of genomic DNA was performed using a set of reagents "Real-Best-Genetics Hemostasis (12)". A CFX96 amplifier (Bio-Rad, USA) was used to carry out the polymerase chain reaction. The significance level of differences between the groups was determined using the criteria χ2, Mann–Whitney and Fisher's exact criterion. Results. The C allele of SNP of ITGB3:1565 β3 integrin gene (T/C) tends to be associated with a more severe course of the disease (p = 0.048). The C allele of SNP of β3 integrin gene ITGB3:1565 (T/C), the T allele of SNP of α2 integrin gene ITGA2:807 (C/T), and the T allele of SNP of methylenetetrahydrofolate reductase gene MTHFR:677 (C/T) tend to be associated with higher mortality with COVID-19 (p < 0.05). Conclusion. The minor allele of SNP of ITGB3:1565 (T/C) gene can be considered as a predictor of the severe course of COVID-19, minor alleles of SNP of ITGB3:1565 (T/C), ITGA2:807 (C/T), and MTHFR:677 (C/T) genes can be considered as predictors of a higher risk of a lethal outcome. Key words: COVID-19, single nucleotide gene polymorphisms, blood coagulation system, folate cycle

Udmurt Republic is an endemic region for hemorrhagic fever with renal syndrome (HFRS). An extremely high incidence of COVID-19 in 2020-2021 worldwide and in Udmurt Republic in particular suggests that patients might bear these two infections simultaneously. In this article, we report a case of mixed COVID-19 plus HFRS infection. Specific clinical manifestations of HFRS in a COVID-19-coinfected patient included long-term fatigue, thrombocytopenia, iso(hypo)sthenuria, polyuria, episodes of sinus tachycardia and hypertension. On the other hand, the main clinical characteristics of COVID-19 in a HFRS-coinfected patient included no clinical signs of respiratory failure and relatively high saturation despite a substantial lung damage. In general, mixed infection is a risk factor that aggravates the disease and can worsen outcome. However, simultaneous infection of a cell with more than one virus probably causes viral interference, which results in suppression of one or both viruses. Key words: COVID-19, hemorrhagic fever with renal syndrome, viral interference

Objective. To develop the pattern of early cardiovascular disorders in patients with primary hypothyroidism based on the analysis of relationship between patient’s thyroid status and some functional cardiovascular parameters depending on compensation status. Materials and methods. The examination of 163 women aged 62 [55;67] years with primary hypothyroidism was performed. The patients were divided into groups: 1 group included 54 patients aged 62.0 [57;68] years with subcompensated disease, 2 group consisted of 15 patients aged 59 [53;66] years with non-compensated disease and 3 group included 94 patients aged 63 [53;66] years with compensated hypothyroidism. Physical examination, transthoracic echocardiography, assessment of global left ventricle longitudinal strain by speckle tracking method, endothelial function and laboratory tests were performed to all patients. Regression analysis using thyroid stimulating hormone, free T4, age, duration of the disease, cause of hypothyroidism, menopause presence and natural thyroid stimulating hormone logarithm as predictors and some cardiovascular parameters of heart condition and lipid metabolism as dependent valuables was made. Results. Mathematic modeling demonstrated that the combination such factors as age, duration of disease and thyroid stimulating hormone level is the most important in left ventricle remodeling processes. However, the age only has significant influence on intima media thickness. Conclusion. Left ventricle remodeling, morphologic functional status of blood vessel wall and decrease of glomerular filtration rate are basically determined by such modified and non-modified factors as body mass index, age, duration of hypothyroidism and thyroid stimulating hormone level.

The article presents modern views on the problem of gastroesophageal reflux disease (GERD). Data on the prevalence and risk factors for the development of the disease are presented. Emphasis is placed on the special role of slightly acidic and slightly alkaline reflux in the pathogenesis of GERD, which, in combination with dysfunction of the lower esophageal sphincter and impaired motor-evacuation function of the stomach, are important factors, determining the the lack of effectiveness of standard antisecretory therapy. The exceptional importance of the 24-hour pH impedanceometry method is emphasized for the differential diagnosis of the non-erosive form of GERD with functional heartburn and hypersensitivity of the esophagus to reflux (the so-called hypersensitive esophagus). The data of the results of domestic and foreign studies devoted to the evaluation of the effectiveness of the use of physiotherapeutic methods and drinking balneotherapy in patients with GERD are given.

One of the typical manifestations of hemorrhagic fever with renal syndrome (HFRS) is a damage to the cardiovascular system. The most promising direction of studying the causes of cardiac complications in HFRS should be considered the genetic patient characteristics, particularly taking into account the disease pathogenesis, study of polymorphism of the genes in the blood coagulation system and the folate cycle. The aim of the study was to find out an effect of polymorphism of the blood coagulation system and folate cycle genes on heart damage in hemorrhagic fever with renal syndrome. A case-control study was conducted by enrolling 19 patients in the 2019 summerautumn period at the Republican Clinical Infectious Hospital in the City of Izhevsk. The study of polymorphism of the blood coagulation system and folate cycle genes was performed by using a set of reagents RealBest-Genetics Hemostasis (12) on the CFX96 amplifier (Bio-Rad, USA). DNA was extracted from peripheral blood leukocytes with reagents RealBest Extraction 100. Transthoracic echocardiography was performed on a Vivid 7 Dimension ultrasound scanner (GE Healthcare, USA) with a matrix sector sensor M4S with a phased array at scanning frequency of 1.54.3 MHz. Statistical analysis was performed using Statistica 12, IBM SPSS 22. The group parameters were calculated and depicted as median and interquartile range (ME [Q25; Q75]). Comparison of such parameters was carried out by using the MannWhitney criterion. Comparison of the frequency distribution for genotypes and alleles in the study groups was carried out using the criterion 2. The association of alleles/genotypes with a predisposition to detectable changes was assessed by the risk ratio (OR) additionally calculating 95% confidence interval (CI). The p 0.05 was considered as statistically significant. During the study, 7 patients were found to have floating echoes on the aortic valve in the outlet of the left ventricle signs of thrombotic endocarditis. In the group of patients with signs of thrombotic endocarditis, there was revealed a higher frequency of the allele A for the F7:10976 G/A gene compared to patients lacking signs of thrombotic endocarditis (p = 0.0357). All study patients had a normal left ventricular ejection fraction (more than 50%), but during the speckle-tracking study assessing the index of averaged peak longitudinal contractility (GLPS AVG), 11 patients with impaired myocardial contractility were identified. In patients with decreased GLPS AVG, the genotype G/G of the FGB:-455 G/A gene was detected more often compared to patients with preserved myocardial contractility (p = 0.0397). In 8 patients, signs of grade 1 diastolic left ventricular dysfunction were revealed, the prognostic importance of the gene polymorphism related to the blood coagulation system and folate cycle in developing this complication has not been determined.

Aim. To study the morpho-functional parameters of the heart in convalescents of hemorrhagic fever with renal syndrome (HFRS) using echocardiography. Material and methods . The study included 27 patients without any chronic diseases who had severe or moderate HFRS (the main group) within 3 weeks after their discharge from the infection diseases hospital. The reference group consisted of 19 patients comparable by age and gender, without any chronic diseases. Transthoracic echocardiography was the basic method of heart and hemodynamics investigation. The test was performed using tissue Doppler and non-Doppler assessment of left ventricle systolic deformation method (speckle-tracking method). Results. Violation of longitudinal systolic deformation of the left ventricle was observed in 15 (55.6%) patients, which was combined with diastolic left ventricle filling by the type of relaxation violation in 8 (29.6%) cases. Mitral valve insufficiency of 1 degree was identified in 11 (40.7%) HFRS patients, insufficiency of the tricuspid valve of 1 degree was identified in 4 (14.8%) patients. Pericardial effusion was detected in 2 (7.4%) patients. In 7 (25.9%) patients in the first 3 weeks after discharge from the hospital, additional floating echoes were detected on the leaves and fibrous ring of the aortic valve, which were considered as a manifestation of thromboendocarditis. Conclusion . Further investigation is necessary to assess the prognostic value (including the risk of thromboembolic complication developing) of the changes revealed in HFRS convalescents and to support the inclusion of echocardiography in the examination program during dispensary observation of HFRS-convalescents.

Aim. To assess the predictive value of single-nucleotide polymorphisms of hemostasis and folate cycle genes in hemorrhagic fever with renal syndrome (HFRS). Methods. 43 patients undergoing HFRS were examined based on the Republican clinical infectious diseases hospital in Izhevsk. Toxic shock syndrome (TSS) in the decompensated phase, pulmonary edema in the alveolar phase, and acute kidney injury (AKI) at stage F [RIFLE criteria (risk, injury, failure, loss, end-stage renal disease)] were registered as complications. Molecular analysis of patients genomic DNA was performed after its isolation from peripheral blood cells. Genotyping was performed by using multiplex real-time PCR with conformationally restricted probes. Statistical analysis was performed by the licensed program SPSS 22.0; the significance level of difference between groups was determined using the nonparametric MannWhitney test (for quantitative variables) and the Fishers exact test (for qualitative variables). Results. The C/C genotype of the ITGB3:1565T/C gene (p=0.0278), and the C/C genotype of the MTHFR1298 A/C gene (p=0.0407) was less common in severe cases, while the G allele of FGB:455G/A gene (p=0.046) and the T allele of the ITGB3:1565T/C gene (p=0.0166) was more frequent. More frequent detection of the 5G/4G genotype of the PAI-1:675 5G/4G gene was found in the case of TSS (p=0.0433). Genotype C/C of the ITGB3:1565T/C gene (p=0.0145) and a combination of pathological genotypes A/C and C/C of the MTHFR1298A/C gene (p=0.0004) are less common in the development of AKI at stage F. Conclusion. The molecular genetic analysis makes it possible to identify patients with genotypes predisposing to a severe and complicated course of hemorrhagic fever with renal syndrome.

AIMDiabetes mellitus (DM) is known to be a risk factor in adverse outcomes and complications in many infectious diseases. In the combination of hemorrhagic fever with renal syndrome (HFRS) and DM there are mutually exclusive pathogenetic States - hyperosmolarity, characteristic of DM is layered on the reduction of osmotic blood pressure in HFRS. Under these conditions, the effect of one disease (DM) on the clinical manifestations of another (HFRS) is not obvious. The aim of the work is to find out the clinical features during hfps in patients with DM.MATERIALS AND METHODSThe study is based on the results of the retrospective studies "case - control" - studied the information contained in medical records of patient (form 003/u), who suffered HFRS in 2006-2018. The Selection of cards produced randomly. In the end, there were formed two groups: the first - 981 patient who suffered HFRS and had no signs of diabetes; the second, 33 patients who suffered HFRS on the background of previously existing (28 people), or the first identified (5) diabetes.RESULTSWith a combination of HFRS and DM, a mild course of the disease is 2.5 times more common, there are no severe forms. Among this group of patients, complications are almost 10 times less common, less likely to develop infectious - toxic shock, acute kidney damage (class F by RIFLE), pulmonary edema. The combination of DM and HFRS is manifested by less high and prolonged fever, less high levels of urea and creatinine in the blood.CONCLUSIONHFRS in combination with DM is easier, apparently, high osmolarity of the blood is a stabilizing factor during the disease.

Abstract Background It is well known that the risk of cardiovascular complications becomes higher even in high normal BP ranges. High normal BP is usually asymptomatic in young age. It is important to establish the main risk factors and the initial signs of cardiac dysfunction at early stages of arterial hypertension (AH) formation. Objective To assess the prevalence of leading risk factors and to investigate the global longitudinal strain rate of left ventricle (LV) by speckle tracking (STE) method in young men with high normal pressure. Methods The study involved 80 patients aged 22 (20; 25) years. The first group (I) included 55 subjects with high normal office BP values (130–139/85–89 mm Hg), the second group (II) consisted of 25 subjects with office BP less than 130/85 mm Hg. Anthropometric and blood biochemical parameters were tested in all subjects. The heart status was assessed according to transthoracic echocardiography-data. The test was performed on an expert class apparatus General Electric Vivid 7 in the B and M mode by the pulse wave and color flow Doppler. LV functional status was assessed by STE with GLPS analysis. STE data was obtained in B-mode from three apical positions with a frame rate of 80–90 per minute. longitudinal peak systolic strain (LPSS) in basal, midwall and apical segments as well as a LV walls was assessed in the compared groups. The parameters tested are presented as median, interquartile range, average and standard deviation. Results Both groups were comparable in age. Smoking (25.9% and 28.6%, p=0.54) and total cholesterol (48,1% and 45,5%; p=0,11) were highly prevalent in groups I and II. Overweight is registered significantly more frequently in subjects with high BP (41.5% and 14.3 respectively, p=0.0009). Family history of premature cardiovascular disease, heart rate, diabetes, uric acid were comparable in both groups. The GLPS value was significantly lower in the group with high normal BP than in the reference group: −19,1 (−17,71; −20,2) and −20,9 (−20,6; −22,4) (p=0,0014). The decrease of LPSS at the basal and midwall segments was recorded more often in subjects with high normal BP (p=0.0008 and p=0.0003, respectively). LPSS in all LV walls was significantly lower in group I. LPSS in anteroseptal wall was 18.7±3.4 and 21.1±4.1, p=0.029; in anterior wall it was 19.8±2.9 and 22.3±3.0, p=0.006; in lateral wall it was 18.7±3.3 and 20.9±1.9, p=0.004; in inferolateral wall it was 18.7±3.3 and 21.1±3.2, p=0.017), in inferior was (19.8±3,1 and 22.3±2.2, p=0,002), in inferoseptal was (17.2±3.4 and 19.8±1.6, p=0.0007) in groups I and II, respectively. The nature of revealed changes in the subjects with high blood pressure requires further targeted investigation. Conclusion The multisegment GLPS decrease may be the earliest marker of myocardial dysfunction in the initial stages of hypertension. The contribution of overweight is evident in the persistent BP increase.

AIMSAssessment of global longitudinal strain of left ventricle and coronary bloodflow in patients with primary subclinical hypothyroidism.MATERIALS AND METHODSThe study involved 23 women with primary subclinical hypothyroidism of age from 55 to 75 years. Physical examination, transthoracic EchoCG, coronary bloodflow assessment and global LV longitudinal strain by speckle tracking method were performed to all patients. The data obtained were compared to the results of 20 women without any thyroid diseases comparable to the main group by age and concomitant diseases.RESULTSPatients with primary subclinical hypothyroidism have signs of diastolic dysfunction significantly more frequently than in control group, and increased values of posterior left ventricle wall and interventricular septum thickness. Global longitudinal strain of left ventricle in patients with hypothyroidism was lower than in control group and patients with hypothyroidism had higher FVI values in perforant coronary arteries.CONCLUSIONPatients with subclinical hypothyroidism demonstrated decrease of global longitudinal strain and increase of volume bloddflow rate in performant coronary arteries.

Aims. Assessment of global longitudinal strain of left ventricle and coronary bloodflow in patients with primary subclinical hypothyroidism. Materials and methods. The study involved 23 women with primary subclinical hypothyroidism of age from 55 to 75 years. Physical examination, transthoracic EchoCG, coronary bloodflow assessment and global LV longitudinal strain by speckle tracking method were performed to all patients. The data obtained were compared to the results of 20 women without any thyroid diseases comparable to the main group by age and concomitant diseases. Results. Patients with primary subclinical hypothyroidism have signs of diastolic dysfunction significantly more frequently than in control group, and increased values of posterior left ventricle wall and interventricular septum thickness. Global longitudinal strain of left ventricle in patients with hypothyroidism was lower than in control group and patients with hypothyroidism had higher FVI values in perforant coronary arteries. Conclusion. Patients with subclinical hypothyroidism demonstrated decrease of global longitudinal strain and increase of volume bloddflow rate in performant coronary arteries.

Ixodes tick-borne borrelioses (ITBB) are caused by two different spirochetes: Borrelia from the group of Borrelia burgdorferi sensu lato, the agents of the classic Lyme borreliosis (LB), and Borrelia miyamotoi that belongs to the group of Borrelia causing tick-borne relapsing fevers. ITBB caused by B. miyamotoi (BM-ITBB) is a previously unknown infectious disease discovered in Russia. It is known that the LB sequelae may reduce the long-term life guality of convalescents.AIMTo study the follow-up of those who have recovered from new BM-ITBB infection in comparison with persons who have had LB.SUBJECTS AND METHODSThe investigation enrolled 41 patients with BM-ITBB and 41 patients with LB who were treated at the Republican Infectious Diseases Hospital of Udmurtia. Within a year after the disease, they were followed up through clinical and instrumental examination of cardiac performance, expanded biochemical analysis of blood and urine, which could; estimate kidney and liver functions, and psychological questioning.RESULTSAsthenic syndrome and complaints about and objective signs of cardiac dysfunctions persisted supraventricular extrasystoles, left ventricular diastolic dysfunction, and elevated and/or unstable systolic blood pressure were detected in 20-30% of the convalescents for a long time. Kidney dysfunctions were manifested in albuminuria and the decrease of glomerular filtration rate. A year following the disease, 10-20% patients had persistently elevated concentrations of alanine aminotransferase, aspartate aminotransferase, and C-reactive protein and had higher levels of total cholesterol and low-density lipoproteins. The pathological consequences of ITBB were polymorphic and varied in different patients; in general, only 68% of them showed health improvement.CONCLUSIONWe assume that a significant role in the pathogenesis of BM-ITBB and LB is played by vascular endothelial damage possibly associated with the inflammatory and autoimmune aspects of an immune response in Borrelia infection. The consequences of this damage may persist and even intensify during a year, which provokes chronic dysfunction of the heart, kidney, or liver in a number of convalescents.