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Belykh N.A., Kucheryavenkova Y.S., Piznyur I.V., Lashkov A.Y., Anikeeva N.A.

Arterial hypertension (AH) is one of the risk factors for the development of cardiovascular diseases. The frequency of detection of hypertension among the child population ranges from 1 to 18% of the examined children. In recent decades, there has been a rapid increase in the incidence of this pathology worldwide. At the same time, primary hypertension accounts for 10% of children with hypertension under the age of 10 years, and secondary (symptomatic) — 90%. Literature data indicate that hypertension, which occurred in childhood, persists in adults, thereby increasing the risk of mortality from cardiovascular pathology. Among all cases of hypertension in children, in 5–10% of cases, the cause is renal artery stenosis. The article presents data on the prevalence and etiology of secondary hypertension, as well as own clinical observation of the course of this disease in a 17-year-old teenager. The difficulties of diagnosing secondary hypertension in pediatric practice are described.

Averkina L.A., Posevina A.N., Maltsev S.V., Lebedenko A.A.

Objective: to study the features of the influence of the autonomic nervous system on the severity of acute urticaria in children.Materials and methods: 73 children with acute urticaria were examined. Clinical research methods included an analysis of the life history and illness, an objective examination of the child, and recording of a cardiointervalogram.Results: clinical and anamnestic data made it possible to identify features of the course of the disease that were not previously noted before the development of urticaria, such as complaints of pain in the heart, a feeling of difficulty breathing (without the presence of concomitant quincke's edema), dizziness, increased sweating (mainly of the palms and soles); analysis of the initial autonomic tone in children with acute urticaria; in cases of mild disease, a pronounced predominance of eutonia is observed, which indicates a coordinated increase in the activity of both the sympathetic and parasympathetic parts of the autonomic nervous system, and in patients with a pronounced clinical picture, a noticeable predominance of vagotonia is recorded.Conclusion: The created model for predicting the severity of acute urticaria, taking into account clinical and anamnestic parameters, as well as changes in the functioning of the autonomic nervous system, makes it possible to more objectively assess the severity of this pathology.

Abakarova D.A., Chistyakova G.N., Remizova I.I., Kadochnikova P.A.

Objective: to conduct a comparative characterization of neonatal scales used in assessing severity of condition and predicting outcomes in newborn infants.Materials and methods: the study included 70 newborns born in 2021 until 2022 at the Federal State Budgetary Institution “Ural Scientific Research Institute for Maternal and Child Care”. Depending on gestational age, 3 groups were formed: group 1 included newborns gestational age 23–29.6 weeks (n=24); group 2 included children aged 30–36.6 weeks (n=29) and group 3 included full-term newborns aged 37–40 weeks (n=17).Results: according to the clinical scale for assessing premature newborns, it was revealed that in group 1, in 45.8% of cases, the condition of newborns who scored the highest number of points was assessed as extremely severe and unstable. Mortality in this cohort of children was 36.3%. According to the Transport Index of Physiological Stability scale, the maximum number of points was recorded in 12.5% of premature newborns from group 1, whose condition was assessed as extremely severe and unstable, but no death was detected in this subgroup. According to the clinical risk index for young children, a lethal outcome was detected in 66.7% of cases in the 1st group in newborns with 7–9 points, while in the 3rd group, a lethal outcome was detected among newborns who scored 4–6 points.Conclusions: currently, the task of creating a universal scale for assessing not only the severity and stability of the condition of newborns, but also predicting adverse outcomes remains urgent.

Sobolevskaya M.S., Gvozdeva A.D., Svirida O.N., Filatova A.Y.

Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure (HF) worldwide and is characterized by a severe course, poor prognosis, and limited effective treatments. To date, there are no reliable prognostic algorithms to identify high-risk patients, and prognostic significance has been determined only for generally accepted clinical and standard resting echocardiographic parameters. The discovery of independent predictors of poor prognosis/severe course of HFpEF is important for determining individual treatment tactics for such patients.The article provides a review of studies devoted to determining clinical, biochemical and hemodynamic predictors of unfavorable progression and prognosis of heart failure with preserved ejection fraction (HFpEF). Significance of assessing of these predictors for determining prognosis and choosing optimal treatment for patients with HFpEF is shown. Directions for further research were identified: identifying phenotypes of HFpEF, developing personalized therapy, construction of prognostic models to identify high-risk patients who require more careful monitoring and/or more intensive drug treatment.

Gafurova N.A., Gorbatova E.V., Strelkova A.V., Postoeva A.V.

Hypercalcemia is a metabolic condition characterized by an increase in total serum calcium concentration above normal. The prevalence of hypercalcemia in the population is about 1–3% according to pilot screening trials, and hypercalcemia is most oſten parathyroid-dependent. In the majority cases hypercalcemia remains asymptomatic, and clinical features are appeared only when the level of total calcium rises to 3,0–3,5 mmol/l. Detection of hypercalcemia in a patient allows the doctor to suspect first the pathology of parathyroid glands - primary hyperparathyroidism or malignant neoplasms, when under the influence of metastases of solid tumors there is destruction of bone tissue. This paper presents a clinical case of hypercalcemia in a patient with severe kidney failure, arterial hypertension and multiple cystic lucencies on radiographs of the leſt shoulder joint. Determination of intact parathyroid hormone concentration within the reference range allows us to reject the hyperparathyroidism and do extend differential diagnostic search. The result of nephrobiopsy was the diagnosis of multiple myeloma, myeloma nephropathy. Unusual for terminal stage of chronic kidney disease hypercalcemia and searching of its cause allows to verify the diagnosis of multiple myeloma in a short period of time.

Volkova N.I., Davidenko I.Y., Degtyareva Y.S.

Objective: to evaluate the clinical characteristics of patients with GDM depending on the treatment received to confirm the presence of various subtypes of GDM.Materials and methods: a retrospective analysis of the medical records of 474 pregnant women with GDM was carried out. The subjects were divided depending on the treatment method received: I group — 353 pregnant women with GDM who received only diet therapy, II group — 121 pregnant women with GDM who used both diet and insulin therapy. Biochemical and general blood tests, coagulograms at the 20th and 30th weeks of pregnancy, ultrasound results, pharmacological history, concomitant complications and pregnancy outcomes were analyzed. The statistical analysis of the results of the study was carried out using R. The differences were recognized as statistically significant at the level of p < 0.05.Results: age, blood pressure, weight and BMI in each trimester and before childbirth did not differ statistically significantly among the groups. Patients receiving insulin therapy had higher levels of urea (p = 0.009), AST (p = 0.03), ALT (p = 0.02), prothrombin (p = 0.02) and D-dimer (p = 0.047). According to the ultrasound data, no significant differences were found. An assessment of the pharmacological history revealed a more frequent use of progesterone preparations in patients with insulin therapy. Concomitant diseases were comparable in patients from different groups.Conclusion: despite the absence of significant differences among the observation groups, the results obtained do not exclude the presence of different subtypes of GSD, but suggest that there is an unjustified prescription of insulin therapy in cases where more intensive dietary changes are required. Of course, further study of this problem is required to confirm the presence of various subtypes of GDM.

Achuvakov R.S., Efremov I.S., Bobrik D.V., Efremova U.S., Khakimova R.A., Asadullin A.R.

Objective: to study the association of single nucleotide variants of the CLOCK gene (rs1801260) and seizures aſter alcohol withdrawal.Materials and methods: 399 patients were analyzed, including 83 women (21%) and 316 men (79%). The average age of the patients was 41.52±8.42 years. The patients were divided into 2 groups. The main group (patients who suffered a seizure in a hospital setting) consisted of 108 patients, 12 women (11%), 96 men (89%), and the comparison group consisted of 291 patients, 71 (25%) women and 220 (75%) men. The examination of patients took place from February 2019 to August 2023. The laboratory study included a comparative genetic examination of two groups of patients: the first group — patients with alcohol dependence syndrome with seizures aſter alcohol withdrawal (F10.2); the second group — patients with alcohol dependence syndrome (F10.2) without seizures aſter alcohol withdrawal. Statistical processing was carried out using Microsoſt Excel, IBM SPSS Statistics 26. During the frequency analysis, the criterion χ² (Pearson Chi-squared) was used, and the odds ratio for each of the genotypes was estimated. The differences were recognized as statistically significant at a significance level of p<0.05. ><0.05.Results: when conducting a frequency analysis of the occurrence of seizures aſter alcohol withdrawal, carriers of the CC genotype had seizures much less frequently than carriers of other genotypes.Conclusion: the presence of the T allele of the CLOCK gene in the genotype is associated with seizures aſter alcohol withdrawal. Moreover, carriers of the homozygous genotype have a higher chance of experiencing seizures than carriers of the homozygous genotype.

Voronin Y.S., Ilkanich A.Y.

Objective: to study the structure of parastomal complications and predictors of their development in patients with intestinal stoma.Materials and methods: a single-center retrospective analysis of the treatment results of 770 (100.0%) patients with colostomy and ileostomy observed in 2019–2023 in the District Center of Coloproctology of the Surgut District Clinical Hospital was carried out. There were 353 (45.8%) women and 417 (54.2%) men in the study group. The average age was 62 (55–68) years. The causes of the stoma were: malignant tumors of the intestine and pelvic organs in 617 (80.1%) patients, benign diseases of the abdominal cavity and pelvis in 153 (19.9%) patients.Results: parastomal complications were detected in 457 (59.4%) people. The most common skin complication is maceration – it was noted in 111 (24.3%) people. The most common complication in the postoperative period was the formation of a parastomal hernia in 142 (31.1%) patients. The average age of people with stoma complications was 63 [56; 69] years (p = 0.003). In addition, it was found that a statistically significant risk factor for complications in the analyzed group was the presence of a loop stoma (p = 0.018). The chances of complications in the group of patients with a loop stoma were 1.511 times higher, the odds differences were statistically significant (95% CI: 1,071–2,131).Conclusions: parastomal complications develop in 59.4% of patients. The most common complications associated with the presence of a stoma develop in persons of both sexes over the age of 63, more oſten in patients with a loop stoma.

Filippenko A.V., Ivanova I.A., Omelchenko N.D., Trufanova A.A.

The purpose of the review was to analyze the literature data on the effect of glucosominylmuramyldipeptide on factors of innate and adaptive immunity in the treatment and prevention of various infectious diseases. The purpose of the review was to examine studies conducted over the past 20 years concerning the use of GMDP for the treatment and prevention of infectious diseases of various etiologies. The literature was searched using databases such as RSCI, eLibrary, MedLine. The following search words were used: muramyldipeptide, muramyldipeptide mechanism of action, glucosominylmuramyldipeptide for the treatment of infectious diseases, glucosominylmuramyldipeptide for the prevention of infectious diseases, glucosominylmuramyldipeptide as an adjuvant. GMDP is an activator of innate and acquired immunity, strengthens the body's protection against viral, bacterial and fungal infections, and also has an adjuvant effect in the development of a post-vaccination immune response, which determines the prospects for its further use to improve treatment regimens and specific prevention of various infectious diseases.

Trunova O.A., Gulmamedova I.D., Maylyan E.A.

Objective: to evaluate the effect of personalized immunotherapy on the frequency of pregnancy and gestation in women with recurrent implantation failure.Materials and methods: the clinical immunogram before and aſter courses of personalized immunotherapy in 65 women with a history of recurrent implantation failure during the period of preparation for treatment under the ART program (24 cryoprotocols in the natural cycle, 41 cryoprotocols with hormone replacement therapy without pituitary blockade): CD3+, CD3+CD4+, CD3+CD8+, CD3+CD20+, CD16+ in direct reaction of surface immunofluorescence using monoclonal antibodies; concentration of serum Ig G, A, M by ELISA; total circulating immune complexes; Nitroblue tetrazolium (NBT) dye reduction test; phagocytic activity of neutrophils.Results: the immune status of 100% of patients with secondary infertility and 36.4% of women with primary infertility is characterized by secondary T-immunodeficiency and significant activation of both B-lymphocytes and cellular factors of nonspecific body protection — peripheral NK cells (CD16+) and neutrophils. Repeated courses of personalized immunotherapy in women with a history of recurrent implantation failure led to normalization of altered immune parameters and showed their effectiveness in 67.7% of patients who gave birth to live children.Conclusion: one of the leading reasons for habitual ineffective implantation in the presence of euploid embryos of good quality is general and local (endometrial) immunological imbalance. A personalized approach to the selection of immunotherapy for each patient optimizes the frequency of implantation, the onset and outcome of pregnancy.

Shlyk I.F., Kharitonova M.V., Morgunov M.N., Blinov I.M., Vasilyeva E.D., Besedina D.Y.

The presented literature review allows us to understand and supplement the existing ideas about the pathogenesis of coronary calcification and aortic valve calcification at the stage of formation of these changes. To study in detail the participation of the most studied immunocompetent cells of innate immunity, such as macrophages, dendritic and mast cells, neutrophils, natural killers in calcification of arteries and aortic valve, their functional role in the progression of this process. The review also presents gaps and missing data present in the study of these cell populations, the replenishment of which will contribute to the development of targeted therapy for the calcification process.The search for literature sources was conducted in the following databases: Scopus, web of Science, MedLine, The Cochrane Library, RSCI, Springer, Science Direct — taking into account the year of publication (no more than 10 years), language of publication (English/Russian), availability of full-text publications and access to them.

Cherkasov D.M., Cherkasov M.F., Tat’yanchenko V.K., Starcev Y.M., Melikova S.G., Galashokyan K.M., Skuratov A.V., Endorenko K.V.

Objective: enhancement the outcome of treatment of patients with complicated forms of hiatal hernia (HH) on the base on a devised personal complex approach.Materials and methods: the review was carried out of 204 patients with complicated forms of HH at the age of 17 to 77 years (men — 44%, women — 56.4%). All 204 patients suffered from gastroesophageal reflux disease (GERD). In 53 (26%) cases synthetic mesh implants were used during surgical management. In 38 patients (18.6%) with hiatal hernia and metaplasia of the esophageal mucosa (ESM) exposed to complex treatment, which includes antireflux surgical management and argon plasma coagulation (APC).Results: early postsurgical complications we met more oſten in the group of patients the ones we used mesh. Late postsurgical complications in the group of patients where mesh implants were used according to the indications were met less oſten. when assessing the quality of life according to the questionnaires GERD-HRqL and GSRS, the subjective symptoms of GERD decrease dramatically aſter surgical treatment (in 3 months), continue to decline up to 12 months, aſter which they acquire a constant character. In patients with hiatal hernia, which has become complicated by ESM metaplasia, aſter completing the courses of argonoplasmic coagulation, in all cases, complete regression of the metaplastic epithelium was registered by us.Conclusions: surgical management of complicated forms of HH using video laparoscopic technique based on the developed algorithm is highly effective, which is confirmed by the low quantity of postsurgical complications and a major improvement of the quality of life of patients.

Lebedenko E.Y., Bespalaya A.V., Mikhelson A.A., Feoktistova T.E., Kormanukov H.Y.

Objective: to substantiate the reserves for reducing the frequency of cesarean section in a level 3 A hospital by retrospectively analyzing delivered patients using the M. Robson classification.Materials and methods: a retrospective analysis of 3771 birth histories of patients delivered in 2017 at the Rostov State “Perinatal center” was carried out. The patients were divided into 10 groups according to M. Robson's classification. The results were processed using mathematical statistics methods using MS Excel 2010 soſtware.Results: an analysis of delivery methods showed that out of 3,771 deliveries, 2018 women were delivered by abdominal delivery, which accounted for 53.2% of the total number of births in 2017. A detailed analysis of the indications for cesarean section in each of the groups according to M. Robson's classification revealed the true reserve for reducing the overall level of abdominal delivery in the studied institution.Conclusions: in order to structure in detail the reserves for reducing the frequency of cesarean section in a particular institution and to compare this indicator between maternity care institutions, in addition to the traditional analysis according to M. Robson's classification, it is necessary to develop and implement a unified form of analysis taking into account indications for abdominal delivery.

Popova A.Y., Kharseeva G.G., Volkova A.E., Shlyk S.V.

The article analyzes materials from the State Archive of the Rostov Region about Zinaida Vissarionovna Ermolyeva, an outstanding Soviet microbiologist and epidemiologist, academician of the USSR Academy of Medical Sciences, creator of the first domestic drugpenicillin. Data are provided about her years of study at the Rostov Women's Medical Institute, and the nat the Faculty of Medicine of Don University. Archival materials are considered hat testify to the first stages of her career as a teacher and scientist at the Department of Microbiology of Don University.

Gridneva Y.Y., Chesnikova A.I., Khripun A.V., Safronenko V.A., Pashchenko E.V.

Objective: to assess the incidence of newly diagnosed subclinical and manifest hypothyroidism in patients with ST-segment elevation myocardial infarction (STEMI) and to identify angiographic features of coronary artery lesions in this combined pathology.Materials and methods: in all patients with STEMI, the level of thyroid-stimulating hormone (TSH) was determined, and thyroid function was assessed if the TSH level deviated from the norm. Stage I of the study included 441 patients, stage II included 133 patients with STEMI. Depending on the presence of newly diagnosed hypothyroidism, patients were divided into 3 groups: 1st — patients without hypothyroidism (n = 57), 2A group — with subclinical hypothyroidism (n = 42) and 2B group — with manifest hypothyroidism (n = 34). All patients underwent coronary angiography and percutaneous coronary intervention.Results: newly diagnosed hypothyroidism occurred in 27.44% of patients with STEMI: subclinical — in 19.73%, manifest — in 7.7% of cases. Patients with concomitant overt hypothyroidism had significantly more severe atherosclerotic lesions of the coronary arteries compared to patients without hypothyroidism.Conclusion: a high incidence of newly diagnosed hypothyroidism in patients with STEMI was established (27.44% of cases). Multivessel coronary lesions were recorded more often in patients with overt hypothyroidism than in patients with subclinical hypothyroidism and without hypothyroidism.