NEUROCHEMICAL MECHANISMS OF EATING BEHAVIOR CAUSED BY STIMULATION OF THE HYPOTHALAMIC REWARD ZONE
Shabanov P.D., Aslamova Yu.N., Moskalev A.R., Azarenko S.V., Lukashkova V.V.
UDC: 612.821.2
Abstract: Objective. The study was aimed at assessment of nutritional and reinforcing effects of the brain's orexin system and neuropeptide Y upon activation of the lateral hypothalamus in experimental rats. Methods. In Wistar rats with electrodes implanted into the lateral hypothalamus, reactions of electrical self-stimulation, self-deprivation and feeding behavior were studied. For pharmacological analysis, we used the D2 dopamine receptor antagonist sulpiride (5 and 20 mg/kg), the D1 receptor antagonist SCH23390 (0.01 and 0.001 mg/kg), which were administered intraperitoneally 30 minutes before testing the self-stimulation response after determining its background values; selective antagonists of orexin A receptors OX1R SB-408124 and OX2R TCS OX229 (Sigma, USA), as well as a competitive antagonist of Y1 receptors neuropeptide Y BMS193885 (Tocris, UK), which were administered intranasally 20 μg/20 μl 15 min before the behavioral assessment. Results. When electrically stimulating the same electrode in the lateral hypothalamus, two types of responses were observed: 1)the self-stimulation response in the Skinner chamber; 2)the feeding response in fed rats in the feeding behavior chamber. When blocking both D1 and D2 dopamine receptors, a dose-dependent effect of inhibition of the reward system and eating behavior was consistently observed. Comparison of the effects of blockade of different subtypes of dopamine receptors revealed that blockade of D1 receptors by administration of SCH23390 (but not D2 receptors) can lead to an almost complete refusal to press the pedal for self-stimulation and eating food at a fixed stimulation threshold. At the same time, after intranasal administration of the OX1R antagonist SB-408124, but not the OX2R antagonist TCS OX229, a pronounced inhibitory effect on the reinforcing properties of self-stimulation and feeding behavior caused by stimulation of the hypothalamus was observed. In addition, intranasal administration of the Y1R antagonist BMS193885 selectively reduces the impulsive component of emotional eating caused by electrical stimulation of the hypothalamic reward zone, but does not change the reinforcing properties of electrical self-stimulation. Moreover, a 7-day course of the Y1R antagonist BMS193885 reduced sweet food intake in stressed rats. At the same time, BMS193885 reduced hyperactivity caused by the withdrawal of a sweet diet in rats with food addiction. Conclusion. The OX1R antagonist SB-408124, but not the OX2R antagonist TCS OX229, when administered intranasally, inhibits the reinforcing properties of self-stimulation and eating behavior caused by stimulation of the lateral hypothalamus, which allows considering OX1R antagonists as potential pharmacological means for correcting compulsive overeating. The Y1R antagonist BMS193885, when administered intranasally in a course can reduce the level of consumption of sweet foods, as a manifestation of food addiction, in stressed rats not receiving food reinforcement.
Key words: самостимуляция, пищевое переедание, дофамин, орексин, нейропептид Y
THE EFFECT OF MELAXEN ON CYTOKINES CONTENT IN MICE WITH EXPERIMENTAL ULCERATIVE COLITIS
Liashev A.Yu., Mal G.S., Solin A.V., Serikov V.S., Antopol’skaya E.V., Lyashev Yu.D.
UDC: 612.112.9
Abstract: Objective. The aim of our study was to assess pharmacological effect of melaxen on the pro- and anti-inflammatory cytokines content of in the colonic wall in mice with experimental ulcerative colitis. Methods. Ulcerative colitis was simulated by replacing drinking water with a 5% solution of dextran sodium sulfate in boiled water for 5 days. Animals were removed from the experiment on the 5th, 7th and 28th days. Melaxen was administered intragastrically at a dose of 0.5 mg/kg body weight in a volume of 0.3 ml once a day for 7 days from the onset of ulcerative colitis simulation. The reference drug sulfasalazine was administered intragastrically in a volume of 0.3 ml at a dose of 200 mg/kg body weight for 7 days. The content of IL-1β, IL-4, IL-6, IL-10, IL-17 in the homogenate of the medial colon was determined by ELISA. Results. An increase in the IL-1β, IL-6 and IL-17 concentration was identified on the 5th-7th days of disease development in mice with ulcerative colitis compared to the naïve group. The IL-4 content decreased on the 5th-7th days of the experiment, while the IL-10 concentration, on the contrary, increased. The IL-6 concentration was significantly higher than in naïve mice on the 28th day. The melaxen administration caused a decrease in IL-1β by 36.6 and 40.4%, IL-6 by 43.2% (only on day 5), IL-17 by 45.6 and 42.6%. A further decrease in the IL-1β and IL-6 concentration was shown on the 28th day. The melaxen administration caused an increase in the anti-inflammatory IL-4 and IL-10 concentrations on the 5th-7th days compared to the control group. No effect of melaxen on the content of anti-inflammatory cytokines has been identified in chronic colitis. The pharmacological effect of melaxen is more potent than sulfasalazine one. Conclusion. The corrective melaxen effect on the inflammatory cytokines production is supposed to be associated with the suppression of the Th1 lymphocytes activity.
Key words: язвенный колит, мелаксен, провоспалительные и противовоспалительные цитокины, мыши
THE ROLE OF HYDROGEN SULFIDE GAS MEDIATOR IN THE REGULATION OF STABILITY OF ERYTHROCYTE MEMBRANES UNDER HYPOOSMIA
Vasilevich M.V., Khodosovsky M.N.
UDC: 612.111.6
Abstract: Objective. The effect of sodium hydrosulfide as a hydrogen sulfide donor on the osmotic resistance of erythrocytes was investigated. Methodology. The study involved white male laboratory rats, weighing 240-260 g, kept in standard vivarium conditions. Fresh mixed venous blood was used for analysis. Blood sampling was performed with proper analgesia in accordance with the requirements of the Ethical Commission for Humane Treatment of Animals of Grodno State Medical University. To determine the osmotic resistance of erythrocytes the method developed by Gorshkova M.A. et al. (2017) was used in the study. Results. When sodium hydrosulfide was added at a concentration of 100 mmol/l, hemolysis of erythrocytes in 0.45% NaCl solution increased and amounted to 64.9%, while without NaHS it was only 33.9%. It was found that when sodium hydrosulfide was added at concentrations of 50, 25, 10, and 1 mmol/l, the degree of erythrocyte hemolysis in rats decreased and was 4.5%, 11.1%, 8.1%, and 23.1%, respectively. The level of reduced glutathione at the addition of sodium hydrosulfide at a concentration of 100 mmol/l increased and amounted to 46.1%, while without NaHS it was 2.56%. When sodium hydrosulfide was added at concentrations of 50, 25, 10 and 1 mmol/l, the rate of hemolysis of erythrocytes in rats was 18.9%, 4.05%, 23.9%, 18.5% respectively. Conclusion. The conclusion has been made about the membrane-stabilizing effect of H2S which is supposed to be associated with a decrease in the level of reactions of free-radical peroxidation of membrane lipids in erythrocytes.
Key words: осмотическая резистентность эритроцитов, гипоосмия, сероводород, гидросульфид натрия, глутатион
ETIOLOGICAL STRUCTURE OF COMPLICATED URINARY TRACT INFECTIONS IN THE BRYANSK REGION: RESULTS OF AN INITIATIVE STUDY
Kuleshov A.A., Danilov A.I., Evseev A.V.
UDC: 612.821
Abstract: Objective. To study the etiological structure of complicated urinary tract infections in the Bryansk region. Methods. As part of the initiative study, the analysis of isolated pathogens in patients with complicated urinary tract infections in the Bryansk region was carried out. Results. The study included 147 cases of complicated urinary tract infection. In the course of microbiological diagnostics, samples of freely released urine (an average portion) were examined. At the same time, an etiologically significant pathogen was isolated in 140 cases. Escherichia coli and Klebsiella spp. were most often identified in the structure of the isolated pathogens. and Enterococcus spp. Conclusions. The main principle of treatment of complicated urinary tract infections is to eliminate the complicating factor (correction of glycemia, urine derivation in ureterohydronephrosis, immunocorrection, removal of foreign bodies, etc.), as well as the appointment of adequate antimicrobial therapy. In turn, optimal antimicrobial therapy depends on the severity of the disease and the possibility of isolating etiologically significant pathogens.
Key words: осложненные инфекции мочевыводящих путей, этиологическая структура, антибиотикорезистентность, антимикробная терапия
SEVERE CYSTITIS: EFFECTIVENESS AND RATIONALITY OF ANTIBIOTIC THERAPY IN THE REPUBLIC OF BELARUS
Bogdel V.V., Vdovichenko V.P., Kozlov S.N., Bogdel A.V., Korshak T.A., Bronskaya G.M.
UDC: 616-08-035
Abstract: Objective. This study analyzes the efficacy, rationality, and cost-effectiveness of various antibacterial therapy regimens. Methods. The study was performed at the Urology Department of the Grodno City Clinical Emergency Hospital from March 2023 to February 2024 and included 112 patients (84 female and 28 male patients) aged 18 to 70 years with diagnosed severe acute cystitis. Results. The combination of cefixime + amikacin may be preferable in terms of clinical outcomes and treatment costs. Conclusion. Severe cystitis requires aggressive initial antibacterial therapy with mandatory monitoring of laboratory markers of inflammation. Since increasing resistance of uropathogens limits the effectiveness of oral antibiotic monotherapy in severe forms of the disease, the combination of cefixime + amikacin may be more preferable in terms of clinical outcomes and treatment costs.
Key words: тяжёлый цистит, комбинированная антибиотикотерапия, цефиксим, амикацин
FEATURES OF CORONARY MICROVASCULAR MORPHOLOGY IN DIFFERENT ETIOLOGIES OF HEART ISCHEMIA
Dmitriev I.V., Ignatova N.B., Abrosimov S.Yu.
UDC: 616-091.8.16
Abstract: Objective. The aim of the study performed was to identify changes in the microvessels of the coronary bed in ischemic heart disease of various etiologies. Methods. Full-text versions of publications devoted to changes in the coronary microcirculatory bed in ischemic heart disease of various etiologies were used. These publications were taken from international and domestic databases (PubMed, Web of Science, Scopus, eLibrary, RSCI) by systematic online search. At the same time, different search queries were used, including combinations of keywords. Research was carefully selected by relevance. Priority was given to original papers. Results. The article provides a detailed analysis of morphological changes in the microcirculatory bed (MCR) in case of ischemic heart disease associated with coronary microvascular disease (CMD) of various etiologies. In particular, the article examines the structure of arterioles, capillaries, and the surrounding stroma in case of angina pectoris without obstructive atherosclerosis of the epicardial coronary arteries (CA), arterial hypertension, cardiomyopathies and other pathologies. However, there are many common features in CMD of different etiologies including a decrease in the number of capillaries with changes in their structure, changes in the structure and function of endotheliocytes, remodeling of the remaining microcirculatory vessels (especially arterioles), and an increase in the amount of connective tissue in the myocardium. Conclusion. It is important to reconsider the attitude toward coronary heart disease (CHD), which in most cases is understood as myocardial ischemia associated mainly with atherosclerosis of epicardial CA. This is often true. However, underestimation of the pathology of coronary MCR of various etiologies does not provide any positive result in some cases. Moreover, atherosclerosis itself is a spatially heterogeneous process. Therefore, in the absence of CA stenosis and the presence of clinical and instrumental data for myocardial ischemia, it is necessary to consider the possibility of developing different variants of CMD. It may be worth considering the following classification of CMB to standardize approaches to its diagnosis, taking into account its etiology: I. In relation to coronary artery atherosclerosis: 1) CMD without coronary artery atherosclerosis; 2) CMD with minimal hemodynamically insignificant coronary artery atherosclerosis (stenosis less than 50%); 3) CMD with stenotic hemodynamically significant atherosclerosis of the coronary arteries (stenosis of more than 50%). II. According to diagnosed chronic diseases that can significantly change the coronary microcirculatory bed: 1. Primary CMD (without chronic diseases); 2.Secondary CMD (in chronic diseases); 3) Mixed form of CMB. It is clear that there will also be the third (clinical) section of this classification, which may include such forms of CMD as microvascular angina, myocardial infarction without obstructive CA, cardiac syndrome Y, and others. However, this section, as well as the classification itself, will require by extensive additional research, and comprehensive discussion. Thus, it will be difficult to achieve significant results in many patients with heart disease without understanding the role of altered MCR in myocardial ischemia and the need to influence it.
Key words: миокард, ишемия, микрососуды, коронарная микроциркуляторная болезнь, дисфункция эндотелия
MULTILEVEL PATHOGENESIS OF DIABETIC KETOACIDOSIS-ASSOCIATED COMA: FROM METABOLIC DISTURBANCES TO CEREBRAL DYSFUNCTION
Bykov Yu.V., Obedin A.N., Volkov E.V., Fischer V.V., Yatsuk I.V., Zinchenko O.V.
UDC: 616.379
Abstract: Objective. The aim of the study was to systematize concisely current concepts of the pathogenesis of diabetic ketoacidosis-associated coma (DKA coma), with a focus on the interplay between systemic metabolic disturbances and cerebral mechanisms of injury. Methods. A structured literature review was conducted using PubMed, Scopus, and eLibrary databases. Publications from 2015 to 2025 addressing key pathogenetic aspects of DKA coma were analyzed, including metabolic, inflammatory, vascular, and neurometabolic alterations, as well as data on cerebral complications. Results. DKA coma represents a multifactorial critical condition driven by insulin deficiency and a cascade of metabolic derangements, including ketosis, metabolic acidosis, dehydration, and electrolyte imbalance. Contemporary evidence extends the classical model by highlighting the contribution of systemic inflammation, oxidative stress, mitochondrial dysfunction, endothelial dysregulation, and impaired cerebral perfusion. Central nervous system involvement is associated with perfusion-metabolic mismatch, neuronal energy failure, disturbances of ion homeostasis, and the risk of cerebral edema, which may determine both the severity of acute clinical manifestations and the development of long-term neurological sequelae. Conclusion. Viewing DKA coma as an integrated, multilevel pathogenetic continuum that includes cerebral mechanisms of injury is essential for early diagnosis, justification of individualized therapeutic strategies, and prevention of severe neurological outcomes.
Key words: кетоацидотическая кома, сахарный диабет, церебральная гипоперфузия, митохондриальная дисфункция, воспаление, отёк мозга
SOME FEATURES OF THE CHOICE OF ANTIMICROBIAL THERAPY OF NECROTIZING ENTEROCOLITIS IN NEONATES
Konovalov I.V., Danilov A.I., Snezhkova A.O., Suvorova E.A., Chiz D.V.
UDC: 616.126-002-08
Abstract: Objective. The aim of the study was to highlight the main features of diagnosis and antimicrobial therapy of necrotizing enterocolitis in newborns. Methods. Based on the available information sources, data on the recommended principles of diagnosis and treatment of necrotizing enterocolitis of newborns are presented in the study. Results. Modern NEC diagnostics are shifting toward monitoring biomarkers (I-FABP, fecal calprotectin), which enables identification of intestinal ischemia before radiographic signs appear. Antibiotic therapy is shifting from multidrug regimens to monotherapy with broad-spectrum drugs with antianaerobic activity and shorter treatment courses to preserve the microbiome. Conclusion. Necrotizing enterocolitis remains a significant health problem today resulting in a heavy economic burden, as well as demographic and social losses. Surgical treatment (subtotal colectomy) is indicated in severe forms of the disease that are difficult to treat conservatively.
Key words: некротизирующий энтероколит новорожденных, неонатология, детская хирургия, антимикробная терапия
CORRELATION OF LIPOPOLYSACCHARIDE-BINDING PROTEIN WITH GUT MICROBIOTA AND UROBIOTA IN LIVER CIRRHOSIS
Malaeva E.G., Stoma I.O., Voropaev E.V., Osipkina O.V., Kovalev A.A.
UDC: 577.114.5:[616.34+616.6]:579.61
Abstract: Objective. To investigate the relationship between the level of blood lipopolysaccharide-binding protein and composition of the gut microbiota and urobiota in patients with liver cirrhosis. Methods. A prospective cohort single-center study involved 89 patients with liver cirrhosis, who had their blood lipopolysaccharide-binding protein levels determined and metagenomic sequencing of feces and urine in addition to routine methods. The average age of the patients was 53.5 years, with 50 male and 39 female patients, and severity class A - 20, B - 13, C - 56 patients, without infections - 47, with infections - 42 patients. High-throughput sequencing was performed using the MiSeq genetic analyzer (Illumina, USA) and a protocol based on the analysis of variable regions of the 16s rRNA gene. Data analysis was performed using the Kraken2 algorithm. The significance level α was set to 0.05. The study was registered in Clinicaltrials.gov (NCT05335213). Results. In patients with liver cirrhosis, blood lipopolysaccharide-binding protein has a direct relationship with pathogenic taxa of the gut microbiota and urobiota, which are pathogens of infections ( Pseudomonadota , Gammaproteobacteria, Bacillales, Enterobacter , Enterococcus , Bacillus , Salmonella, Proteus , Pseudomonas , Staphylococcus , Escherichia, Klebsiella, Acinetobacter and others) and feedback - with autochthonous taxa, including involved in the synthesis of short-chain fatty acids ( Bacteroidota, Veillonellales, Lachnospira, Clostridium, Lachnoclostridium, Petroclostridium, Ruminococcus, Coprococcus, Dorea, Butyrivibrio, Anaerobutyricum, Prevotella and others)(p<0,05, pFDR<0,05). Conclusion. Blood lipopolysaccharide-binding protein as a marker of bacterial translocation reflects the pattern of the gut and urinary tract microbiota, which contributes to or prevents the development of infections in liver cirrhosis.
Key words: липополисахарид-связывающий протеин, микробиота кишечника, уробиота, цирроз печени
FEATURES OF EXACERBATIONS OF THE “BRONCHIAL ASTHMA IN OBESE PATIENTS” PHENOTYPE DEPENDING ON THE DEGREE OF OBESITY
Punin D.A., Prygova A.V., Yudenich O.V.
UDC: 616.24
Abstract: Objective. The aim of the study was to investigate the characteristics of exacerbations, prevalence of comorbidities, and the need for high doses of baseline therapy in patients with bronchial asthma with the phenotype “bronchial asthma in obese patients” depending on the degree of obesity. Methods. The study involved 83 clinical patients’ records with bronchial asthma and obesity was conducted. Duration of hospitalization, blood saturation, pulmonary function tests, comorbidities, and treatment were also assessed. We analyzed 83 medical histories of patients with bronchial asthma and obesity who were hospitalized because of exacerbation within the period of 2024. Hospitalization duration, blood oxygen saturation levels, pulmonary ventilation parameters, comorbidities prevalence, concomitant pathology, and the scope of baseline therapy were assessed. Results. Higher degrees of obesity were associated with longer hospitalization period and a higher rate of readmissions, as well as with lower blood oxygen saturation values and a more pronounced decrease in post-bronchodilator FEV1 and FVC. Patients with more severe degrees of obesity had a higher rates of comorbidities such as coronary artery disease (post-infarction cardiosclerosis), chronic heart failure, type II diabetes mellitus, and chronic kidney disease. Patients with high degrees of obesity were more likely to be prescribed high doses of ICS upon discharge. Conclusion. Severe obesity is a factor contributing to the worsening of bronchial asthma exacerbations and an increase in their frequency, longer hospital stays, and an increased need for higher levels of basic ICS therapy to prevent future exacerbations. Severe obesity also leads to greater rate of comorbidities in patients with bronchial asthma.
Key words: бронхиальная астма, ожирение, спирометрия, полиморбидность, базисная терапия
PROBLEMS OF TREATMENT AND PREVENTION OF GERIATRIC SYNDROMES IN OUTPATIENT SETTINGS
Bazhenova D.S., Mikhalik D.S., Golovanova E.D., Dekhnich S.N.
UDC: 616.-053.9-08-084
Abstract: Objective. To study the features of drug therapy in middle-aged and elderly women with osteopenia and sarcopenia in outpatient practice. Methods. 200 women were examined, divided into 2 age groups: 1-45-49 years (n = 100), 2-60-74 years (n = 100), the time of medical examination and preventive examination in the city clinic. Osteopenia was diagnosed using the FURUNO CM-200 light ultrasound densitometer (Japan). EWGSOP 2 criteria were used to detect sarcopenia. Muscle strength was determined using the DK-25-e hand dynamometer, muscle mass on the Multiscan BC-OXi apparatus (Russia), muscle function - with the test "walking speed by 4 meters." The frequency of drugs used to treat and prevent CVDs, DM, osteoporosis in middle-aged and elderly patients was analyzed depending on the presence or absence of certain geriatric syndromes (osteopenia, sarcopenia). Results. The frequency of use of vitamin D and calcium preparations was only 15% and 1% on average, 10% and 2% in old age, which is clearly not enough, given the fairly high incidence of osteopenia and sarcopenia in the study sample. Antihypertensive drugs, statins, metformin were prescribed to patients with chronic non-communicable diseases (NCDs) in accordance with clinical guidelines for these diseases, however, the presence of osteopenia and sarcopenia was not taken into account in the selection of pharmacotherapy due to the fact that the diagnosis of these conditions was not carried out by primary care doctors. Conclusion. Screening for osteopenia and sarcopenia, which are prenosological forms of diseases such as osteoporosis, NCDs and complicating their course, can be carried out on an outpatient basis using available, non-invasive and simple methods - ultrasound densitometry and bioimpedance analysis of body composition. Early diagnosis of these geriatric syndromes in middle age is an approach to personalized medicine within the concept of "healthy longevity".
Key words: остеопения, саркопения, терапия, профилактика
PHYSICIANS' AWARENESS OF DYSLIPIDEMIA
Egorkina Yu.S., Tsareva V.M.
UDC: 616.1:577.125.8
Abstract: Objective. The aim of the study was to assess physicians’ awareness of target LDL-C levels and identify the main reasons for failure to achieve LDL-C targets in patients with dyslipidemia. Methods. An anonymous online survey involved 128 physicians of various specialties in the Smolensk, Bryansk, and Kaluga regions. A questionnaire developed by the Belarusian State Medical University was used. The average age of the physicians was 38.8±0.21 years. 76.1% of the respondents were therapists (GPs), 6.8% were general practitioners, and 17.0% were physicians of other specialties. Statistical analysis of the results was performed using the Statistica 10.0 package. Results. All physicians inclided into the study considered that dyslipidemia was an important health problem affected badly clinical prognosis. Only 74.2% (n=95) of medical doctors demonstrated their competence in the relevant target LDL-C level (less than 1.4 mmol/L) in patients with very high cardiovascular risk. The LDL-C level of less than 1.0 mmol/L for patients with extreme risk was not indicated by all medical doctors included into the study. Physicians recommend insufficient doses of statins to lower lipid levels. The most commonly used drugs and dosages were atorvastatin 20 mg (61.1%) and rosuvastatin 10 mg (64.8%). Only 50% of respondents achieved the target LDL-C level in only 5-10% of cases in patients with dyslipidemia and a very high-risk hypertension. According to the physicians, the main reason for failure to achieve target LDL-C levels is poor patient compliance (92.2%). Conclusion. Physicians are insufficiently aware of the problem of dyslipidemia. The use of high-intensity statins and combination lipid-lowering therapy remains low. The main reason for failure to achieve LDL-C targets is poor patient adherence to treatment. Efforts must be made to increase physicians' awareness of the problem of dyslipidemia, conduct educational events on modern approaches to treating patients with lipid metabolic disorders, and ensure that clinicians are aware of clinical guidelines for managing these conditions.
Key words: дислипидемии, гиполипидемическая терапия, анкетирование, осведомленность врачей
CORRELATION BETWEEN INSTANTANEOUS VALUES OF QT AND RR INTERVALS AS AN BODY FUNCTIONAL STATE INDICATOR
Kozmidiadi A.O., Smirnov A.S., Dubovik E.N., Evseev A.V., Pravdivtsev V.A., Lyamec L.L.
UDC: 612.172.4
Abstract: Objective. Confirmation of the hypothesis about the possibility of the functional state of the body depending on the relationship between the instantaneous intervals QT and RR of the electrocardiogram. Methods. The study involved 7 men and 12 women aged 19-20 who had no health complaints. All subjects underwent a psychometric test in the Stressonika virtual reality (VR) environment using CleverPoint technology. During the VR session, an ECG was recorded in a single lead. The RR and QT intervals were measured by the same specialist after a 2-minute rest period, followed by calculation of the correlation between the eleven QT intervals and the duration of the cardiac cycle which was estimated based on the RR interval that included the QT interval and the preceding RR interval. Results. It has been established that the median values of the QT interval have a weak correlation coefficient with the severity of the stress state and the indicators of heart rate variability. The correlation coefficient between the RR interval and the QT interval in the same cardiac cycle has an average level of correlation with the severity of stress F/gr, HR and SDNN (standard deviation of NN intervals, where NN is the total number of RR intervals of sinus origin): -0.507*, -0.639* and 0.653*, respectively (* - p<0.05). The group of subjects with a positive correlation and the group with a negative correlation significantly differ from each other in such indicators as: F/gr, HR, SDNN, pNN50 (the value of NN50 divided by the total number of NN intervals, where the number of pairs of neighboring NN intervals that differ by more than 50 m/s during the entire record). Conclusion. To calculate the ratio of QT to RR, it is better to use data within a single cardiac cycle. At the same time the direction of the correlation between the instantaneous values of the QT and RR intervals is determined by the functional state of the organism. The rs(RR) indicator can be used as an indicator of stress severity in people aged 19-20 years.
Key words: интервал QT, корреляционная зависимость интервалов QT и RR, функциональное состояние
POSSIBILITIES OF VIBRATION-CONTROLLED TRANSIENT ELASTOGRAPHY IN THE DIAGNOSIS OF METABOLICALLY ASSOCIATED FATTY LIVER DISEASE IN CHILDREN WITH TYPE 1 DIABETES MELLITUS
Ignatieva A.A., Alimova I.L.
UDC: 616.36-003.826
Abstract: Objective. The aim of the study was to assess the diagnostic value of vibration-controlled transient elastography (VCTE) using the controlled attenuation parameter (CAP) for the detection of metabolically associated fatty liver disease (MAFLD) in children with Type 1 diabetes mellitus (T1DM). Methods. The study involved 45 children with T1DM of more than one year duration. Children were divided into two groups: children with normal body weight (n = 30) and overweight children (n = 15). In all patients anthropometric assessment, measurement of HbA1c and ALT levels, and VCTE with CAP evaluation were performed. A CAP value ≥238 dB/m was considered indicative of hepatic steatosis. Statistical analysis was performed using nonparametric methods. Results. CAP values were significantly higher in overweight children compared with those of normal weight (p <0.01). The prevalence of hepatic steatosis (CAP ≥238 dB/m) reached 66.7% in the overweight group versus 20% in the normal-weight group (p =0.03). Elevated ALT levels were detected in 40% and 10% of patients, respectively (p =0.04). The overall prevalence of MAFLD among children with T1DM and excess body weight reached 26,7%. Significant positive correlations were found between CAP and disease duration, HbA1c levels, BMI SDS, and ALT. Conclusion. According to VCTE findings, the prevalence of hepatic steatosis among children with T1DM and excess body weight was 66,7%, while 26,7% of these patients were diagnosed with metabolically associated fatty liver disease.
Key words: метаболически-ассоциированная жировая болезнь печени, сахарный диабет 1 типа, вибрационно-контролируемая транзиентная эластография, контролируемый параметр затухания, дети
COMPARATIVE ANALYSIS OF EYE INJURIES REQUIRING HOSPITALIZATION IN THE SMOLENSK REGION (2024 VERSUS 2010)
Mogilevtsev V.V., Belkova A.G., Sharshkova M.A., Lyamec L.L., Suvorova E.A., Voitova S.P.
UDC: 617.7-001(470.332)
Abstract: Objective. To perform a retrospective analysis of eye injury cases that required hospitalization, based on patient records from the Smolensk Regional Clinical Hospital, comparing the period from January 1, 2024, to December 31, 2024, with the period from January 1, 2010, to December 31, 2010. Methods. The study's inclusion criteria were a clinical diagnosis of a penetrating or non-penetrating injury, contusion, or burn of the eyeball; age 18 years or older. For the retrospective study in 2024, 48 medical records of inpatients treated at the Smolensk Regional Clinical Hospital who met the criteria were selected; in 2010, this number was 54. All patients received a comprehensive examination, followed by surgical and/or conservative treatment as needed, in accordance with medical care standards and clinical recommendations. Results. In 2024, the adult ophthalmology department of the Smolensk Regional Clinical Hospital admitted 48 patients with eye injuries, accounting for 1.3% of the total number of treated patients, compared to 54 (1.6%) in 2010. Gender distribution: in 2024, men - 38 (79.2%), women - 10 (20.8%); in 2010, men - 43 (79.6%), women - 11 (20.4%). The average age in 2024 was 53.1 years, and in 2010 - 51.5 years. The majority of injuries were domestic in nature (45 cases, 93.75% in 2024, and 39 cases, 72.2% in 2010). In 2024, 6 patients (12.5%) and in 2010, 8 patients (14.8%) sought an ophthalmologist's help more than 7 days after the injury. Among patients treated in 2024, 15 (31.3%) had a penetrating eye injury. In 2010, the proportion of such injuries was 48.1% (26 cases). In 2024, wounds affecting all layers of the cornea accounted for 73.3%, and in 2010 - 73.1%. Intraocular foreign bodies were detected in 8 patients (53.3%) in 2024 and in 13 patients (50%) in 2010. Complications such as traumatic cataract, aphakia (due to lens dislocation), and endophthalmitis were observed in some patients with penetrating injuries. In 2024, contusion of the eyeball was diagnosed in 18 patients (37.5%) who sought hospital care due to injury. In 2010, this percentage was slightly lower - 35.5% (6 cases). Most patients (66.6% in 2024 and 76.5% in 2010) had a contusion injury of III-IV severity. Conclusions. In 2024, compared to 2010, there was a slight decrease in the number of patients with visual organ injury requiring hospitalization. The trend towards a decrease in the frequency of eye injuries is probably related to a decrease in the number of active industrial enterprises, improved prevention, in particular, increased public awareness of safety regulations and a natural population decline. Based on our study, in 2024, contusion injuries predominated in the structure of eye injuries requiring hospitalization (18 cases, 37.5%). There were somewhat fewer instances of penetrating eye injuries (15 cases, 31.3%). In 2010, penetrating injuries of the eyeball were diagnosed most frequently (26 cases, 48.1%). Furthermore, in 2024, as in 2010, corneal and corneo-scleral wounds prevailed (73.3% and 73.1%, respectively). A low level of adherence to self-care was observed among patients (in 2024, only 24 out of 48, or 50%, and in 2010, 35, or 64.8%, sought medical assistance within the first 24 hours after the injury). ate treatment may contribute to the development of severe complications and poor prognosis.
Key words: проникающее ранение, контузия, глазной травматизм, внутриглазное инородное тело
STATISTICAL ANALYSIS OF CLINICAL AND MORPHOLOGICAL CHARACTERISTICS AFFECTING THE STAGE OF PROSTATE CANCER
Polunin G.E., Shvorob D.S., Ivanov V.V., Koktyshev I.V.
UDC: 616.65-006.6
Abstract: Objective. The aim of the study was to perform a statistical analysis of clinical and morphological characteristics affecting the stage of prostate cancer. Methods. A retrospective study of 200 patients with prostate cancer was performed. The patients were divided into two groups: Group 1 involved 90 people with localized stage of prostate cancer according to the TNM classification (T1-T2); Group 2 consisted of 110 patients with advanced stage of cancer (T3-T4). In the patients 18 parameters were assessed: patient's age, duration of the disease, place of residence, concomitant diseases, pain and difficulty in urination, antiandrogenic therapy, anemia and leukocytosis, hematocyturia and leukocyturia, PSA level, Gleason score and degree of malignancy of the tumor, identification of regional and distant metastases, prostate volume and localization of the primary tumor. The comparative analysis of the parameters was carried out using the Student's T-test, Mann-Whitney U-test, Z-test or Chi-square. The differences were considered significant at a р ˂ 0,05. Results. As a result of the study, it was found that the signs that significantly (p 0.05) affected the progression of the disease included patients’ age, hemoglobin level, PSA level, pain when urinating, taking antiandrogenic therapy, microhematuria, a total Gleason score 9 and Grade 5, regional and distant metastases, and total damage to the prostate glands. Conclusion. Results of the study confirm complex relationships between demographic, clinical, and morphological characteristics and the stage of prostate cancer. The key markers of the prevalence of the disease are as follows: age, pain and hematuria, anemia, PSA levels, antiandrogenic therapy, the presence of a low-grade tumor variant, regional and distant metastases. On the contrary, a number of factors such as the duration of the disease, place of residence, leukocytosis and prostate size do not significantly affect progression of prostate cancer.
Key words: рак предстательной железы, статистический анализ, клинические факторы, морфологические факторы
EFFECTIVENESS OF SURGICAL TREATMENT OF VARUS DEVIATION OF THE FIFTH TOE USING OPEN AND PERCUTANEOUS TECHNIQUES
Imankulov M.A., Aliev R.N., Hayrapetov G.A., Osnach S.A.
UDC: 617.586.5-089.844
Abstract: Objective. The aim of the study was to assess the effectiveness and improve the results of surgical treatment of varus deformity of the fifth toe using both open and percutaneous techniques. Methods. The data of 34 patients who underwent 41 surgical procedures using open and percutaneous techniques were analyzed. To assess the effectiveness of the treatment, the foot functional index scale (FFI, Foot Function Index) and the visual-analog pain scale (VAS) were used. Results. The study demonstrated a significant improvement in clinical and radiological parameters after correcting the varus deformity of the fifth toe. The average index of the fourth metatarsal angle decreased from 12.2° before surgery to 4.4° in the postoperative period (p < 0.05). There was also a statistically significant decrease in the level of pain syndrome: on the VAS scale, the average values decreased from 8.1 to 2.1 by the time of the last visit. The functional parameters in the patients improved significantly. The improvement was was confirmed by a decrease in the average FFI from 19.3 to 4.1. Conclusions. The most important conclusion of the study is the comparability of the clinical effectiveness of minimally invasive and open methods of correction of varus deformity of the fifth toe.
Key words: метатарзалгия, деформация Тейлора, деформация переднего отдела стопы, чрескожная хирургия
LONG-TERM BRAIN STRUCTURE CHANGES AFTER LOW-LEVEL TOTAL BODY IRRADIATION: DISEASE RISK FACTORS AND PREDICTORS (40 YEARS SINCE THE CHERNOBYL ACCIDENT)
Meshkov N.A., Kulikova T.A., Valtseva E.A.
UDC: 613.6.02
Abstract: Objective. The aim of the study was to explore the way certain risk factors and condition of the cardiovascular system affect the development of cerebral atrophy and microangiopathy. Methods. We have examined 69 people of comparable age, including the study group (48 liquidators of the Chernobyl accident; 37 of them participated in the emergency response in 1986 and 11 were active in 1987-1988; they received radiation doses of 0.199(0.071) Gy, 0.233(0.054) Gy, and 0.130(0.044) Gy, respectively) and the comparison group (21 subjects). Their cardiovascular system was assessed using standard indicators. Statistical analysis was performed with the help of STATISTICA 10.0. Results. In the study group, cerebral atrophy was found in 93.8% of the liquidators; in the comparison group, in 81.0% of those examined; microangiopathy was detected in 100% and 85.7% of the subjects. Among the liquidators active in 1986, the share of those suffering from cerebral atrophy was 94.6%; among the participants of 1987-1988, the share was 90.9%. In the study group, the severity of cerebral atrophy and microangiopathy was 1.40(0.64) and 1.52(0.68); in the comparison group, 1.10(0.70) and 1.14(0.65). In the liquidators active in 1986, the severity of cerebral atrophy and microangiopathy was 1.46(0.65) and 1.62(0.68); in the liquidators active in 1987-1988, it was 1.18(0.60). We have found that the incidence of atrophy increases with age in both the study group (r=0.446; p=0.002) and the comparison group (r=0.468; p=0.033). In the liquidators, we have also found a correlation between BMI and atrophy (r=0.251; p=0.085) and BMI and microangiopathy (r=0.267; p=0.066). In the study group, Rohrer’s Index (r=0.467; p=0.023) and diastolic blood pressure (r=0.414; p=0.047) are predictors of atrophy, while cardiovascular efficiency can be used as a predictor of microangiopathy (r=0.300; p=0.039). In the liquidators active in 1986, predictors of atrophy include dose (r=-0.576; p=0.013) and diastolic blood pressure (r=-0.705; p=0.003), while cardiovascular efficiency is a predictor of microangiopathy (r=0.394; p=0.016). In the liquidators active in 1987-1988, predictors of atrophy include dose (r=-0.333; p=0.022) and average dynamic arterial blood pressure (r=0,799; p=0,006). Conclusion. The risk factors and predictors identified can be used for diagnosis purposes and for anticipating the consequences of radiation exposure in liquidators of nuclear accidents working with sources of ionizing radiation, as well as in radiotherapy patients.
Key words: ликвидаторы последствий аварии на ЧАЭС, дисциркуляторная энцефалопатия, атрофия, микроангиопатия, факторы риска, предикторы
THE IMPACT OF IRON OVERLOAD ON THE CLINICAL COURSE OF NON-ALCOHOLIC FATTY LIVER DISEASE AND DIAGNOSTIC APPROACHES
Volk T.G., Osipova V.A.
UDC: 616.36-071
Abstract: Objective. To generalize the available data on non-alcoholic fatty liver disease and iron overload, and to identify the impact of their combination on the clinical course and diagnostic approaches. Methods. An analysis and generalization of publication data on non-alcoholic fatty liver disease and iron overload has been performed. Results. Data analysis revealed that iron overload has a potentiating effect on the course of non-alcoholic fatty liver disease by enhancing inflammatory processes in the liver tissue and exacerbating metabolic disorders. This leads to an accelerated transition from non-alcoholic steatosis to steatohepatitis, increased fibrogenesis with a high risk of cirrhosis and hepatocellular carcinoma, as well as an increased risk of developing type 2 diabetes mellitus and cardiovascular diseases. The detection of hyperferritinemia with a normal or slightly elevated level of transferrin iron saturation (<45%) allows for the suspicion of secondary iron overload, which is confirmed by magnetic resonance imaging and morphological examination of the liver. Conclusion. Given the prevalence and negative impact of dysmetabolic iron overload syndrome on the course of non-alcoholic fatty liver disease, it is important to consider the potential co-occurrence of these conditions. Timely diagnosis of iron metabolism disorders helps reduce liver damage, decrease the severity of metabolic syndrome components, prevent the development of cirrhosis and hepatocellular carcinoma, and significantly improve the prognosis for type 2 diabetes mellitus and cardiovascular complications.
Key words: неалкогольная жировая болезнь печени, перегрузка железом, метаболический синдром, гепсидин, метаболизм железа
FACTORS DETERMINING PSYCHOLOGICAL HEALTH OF PARENTS AND THEIR INFLUENCE ON PERFORMANCE OF DOCTORS IN CHILDREN'S HOSPITALS
Legonkova T.I., Ulasen T.V., Krushelnitskaya Yu.V., Skidan T.N., Krushelnitsky A.A., Shtykova O.N., Deineko O.Ya., Arshanskaya O.D., Marchenkova Yu.V., Skidan I.N.
UDC: 616-053.2:154.2
Abstract: Objective. The aim of the study was to analyze the experiences of parents with children in Intensive Care Units (ICUs). Methods. The Russian-language eLibrary platform, as well as the English-language PubMed, BMC, and Scopus databases were used to search for relevant information. Of the selected publications, the most significant studies by both Russian and international authors were selected for further assessment. Results. Potential types and sources of parental stress are described in details. Studies examining various aspects of parental attitude toward medical care in ICUs are summarized to identify approaches aimed at improving this indicator. Conclusion. When children are hospitalized to ICUs, medical specialists should be alert to provide targeted preventive care, provide proper monitoring and support to those particularly vulnerable to negative consequences. This approach is able both support parents and help children get crucial adult support for their proper emotional and physical well-being.
Key words: пациентоцентрированный подход, удовлетворенность пациентов, новорожденный, недоношенный ребенок, отделение реанимации и интенсивной терапии
CLINICAL CASE OF HEART TRANSPLANTATION COMPLICATED BY END-STAGE RENAL DISEASE AND SUBSEQUENT KIDNEY TRANSPLANTATION
Chudaeva O.V., Bogdanovich A.S., Chinchenko M.A., Yatskovskaya Ya.S., Zhukova N.A.
UDC: [616.12+616.61]-089.843
Abstract: Objective. The aim of the study was to analyze a medical history of a patient with heart transplantation and subsequent kidney transplantation resulted from certain complications; study the management features of recipients with sequential multi-organ transplantation; as well as assess the spectrum of early and long-term complications. Methods. Patient survey, physical examination, analysis of medical records, data from laboratory and instrumental studies. Results. A clinical case is presented of a female patient with dilated cardiomyopathy (DCM) and end-stage chronic heart failure, which required orthotopic heart transplantation (OHT), performed in June 2013 at the V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs. During preoperative preparation, a severely reduced left ventricular contractile function (ejection fraction 25-28%), dilation of its chambers, and pulmonary hypertension were identified. In the postoperative period, primary graft dysfunction developed, which was managed with central extracorporeal membrane oxygenation (ECMO). The subsequent course was complicated by acute renal failure (ARF), requiring hemodiafiltration and later transition to chronic program hemodialysis. In October 2013, the patient developed severe bilateral pneumonia with acute respiratory failure, necessitating mechanical ventilation and repeated use of peripheral veno-venous ECMO. Positive dynamics was achieved with aggressive antimicrobial and supportive therapy. In the long-term period (2014), end-stage chronic renal failure developed, which became the indication for kidney transplantation performed in September 2016. During long-term follow-up (until 2022), according to regular echocardiograms, coronary angiograms, and endomyocardial biopsies, the function of the heart graft remained stably satisfactory (ejection fraction 66-74%) without signs of cellular or humoral rejection. Satisfactory function of the kidney graft was also noted. Conclusion. Orthotopic heart transplantation and subsequent kidney transplantation were the only radical treatment methods that enabled the transition of the patient from end-stage heart and kidney failure to a state of stable clinical compensation. Adequately selected lifelong immunosuppressive therapy ensured the long-term and satisfactory functioning of both grafts throughout the observation period (over 9 years). This clinical case demonstrates the high efficacy and safety of sequential multi-organ transplantation, as well as the possibility of returning patients to an active life, provided a comprehensive interdisciplinary approach and lifelong dynamic monitoring are in place.
Key words: дилатационная кардиомиопатия, терминальная сердечная недостаточность, ортотопическая трансплантация сердца, острая почечная недостаточность, хроническая болезнь почек
CASE REPORT: NON-FUNCTIONING GALLBLADDER IN AN ADOLESCENT GIRL
Pervishko Olesya V., Ivanenko Alina S., Matalaeva Svetlana U., Кirichek Sergei. A.
UDC: 616.36-003.826
Abstract: Objective. The aim of this study was to present a clinical case of cholelithiasis in a teenage girl, analyze the features of her neonatal period, profile of inflammatory cytokines, and characteristics of her intestinal microbiota. This analysis will help us to identify potential risk factors that may affect the progression of the disease and its clinical transformation. Methods. A retrospective analysis of the patient's medical records, including life history and illness, physical examination, laboratory tests, assessment of serum cytokine levels, and 16S rRNA sequencing for characterizing the intestinal microbiota were performed. Results. The patient experienced a transformation from asymptomatic cholelithiasis to a complicated, painful form. Among the first risk factors, artificial feeding and neonatal antibiotic therapy with cephalosporin drugs were considered, because of a congenital defect in the hard and soft palates. Preoperative laboratory tests revealed elevated levels of TNF-α, IL-6, IL-18, IL-1β, and IL-1RA, indicating the activation of pro-inflammatory cascades. 16S rRNA sequencing revealed a significant decrease in the number of Clostridia, with a concurrent increase in Bacteroidia and Proteobacteria. Following laparoscopic cholecystectomy, the patient experienced clinical and biochemical improvements in their condition. Conclusion. This case emphasizes the significance of an interdisciplinary approach to cholelithiasis in children and adolescents. Alterations in the composition of intestinal microbiota and persistent cytokine activation may be key mechanisms underlying disease progression and clinical transformation.
Key words: желчнокаменная болезнь у детей, микробиота кишечника, цитокины, описание клинического случая
A CLINICAL CASE OF DIROFILARIASIS WITH MULTIPLE FORMATIONS OF SUBCUTANEOUS PARASITIC NODES
Rosinkova O.S., Simakina E.N., Khramtsov M.M., Labuzov D.S., Lyakhova A.A., Sterlygova O.A., Ivanov P.A., Barbasova S.G., Dubenskaya L.I.
UDC: 616.8-002.951.21
Abstract: Objective. To assess the epidemiological situation of dirofilariasis in the Smolensk region. To describe a clinical case of dirofilariasis. Methods. Literature on the spread of dirofilariasis in the Russian Federation was analyzed. The medical records of hospitalized patients in the Smolensk region were studied. A rare clinical case of the disease is described. Results. Dirofilariasis in the Smolensk region began to be registered since 2014. The third case of dirofilariasis with the formation of multiple subcutaneous parasitic nodes described is an example of a rare variant of clinical course of this disease. Conclusion. The increasing trend in prevalence of dirofilariasis in the central parts of Russia was seen as a reason to familiarize physicians of various specialties with this pathology, which was uncharacteristic for this regions.
Key words: D. repens, дирофиляриоз, клинический случай
INCOMPLETE INTESTINAL ROTATION COMBINED WITH SITUS INVERSUS TOTALIS
Zrubina O.S., Pujda S.A., Strupeneva U.A., Sinel'nikaova E.V.
UDC: 616-00
Abstract: Objective. To trace an algorithm of diagnostic search for intestinal malrotation in situs inversus totalis using a case of clinical observation. Methods. Our study involved analysis of publications and experience of our own clinical observations of prenatal ultrasound diagnostics of situs inversus totalis in combination with incomplete intestinal rotation. Results. Etiology and pathogenesis, features of prenatal ultrasound diagnostics, differential diagnosis in fetuses with abnormal situs and incomplete intestinal rotation are described in the study. Data from publications on prenatal ultrasound diagnostics of complete situs inversion and intestinal malrotation are analyzed as well. Conclusions. When organ position anomalies are identified, the bowel condition should be assessed. Fetal ascites can be an early sign of intestinal malrotation. The ultrasound "whirlpool sign" is a key sign indicating abnormal mesenteric vessel torsion and fetal intestinal malrotation. Although it can indicate a high risk of volvulus, it alone cannot predict the occurrence or severity of intestinal necrosis. Incomplete intestinal rotation can lead to various types of small bowel obstruction, ranging from stenosis to obstruction. Fetal MRI provides more accurate anatomical visualization, but its clinical application remains limited. Fetal hemodynamic assessment, combined with CTG can be beneficially used to diagnose fetal distress. All newborns with situs anomalies are at risk for intestinal rotation abnormalities and require additional postnatal evaluation.
Key words: situs inversus totalis, незавершенный поворот кишечника, мальротация кишечника, заворот кишечника, пренатальная диагностика
BIOPHARMACEUTICAL RESEARCH OF A MATRIX-TYPE TRANSDERMAL PATCH WITH A COMBINED COMPOSITION BASED ON CHOLINE ALFOSCERATE AND MEXIDOL
Losenkova S.O., Tunina E.D.
UDC: 615.451
Abstract: Objective. In order to study the amount, degree and the rate of transdermal release of ethylmethylhydroxypyridine succinate (Mexidol) from a transdermal patch of a combined composition based on choline alfoscerate, the authors developed a biopharmaceutical study method based on the «Dissolution» test. Methods. A biopharmaceutical study ("Dissolution" test) of a transdermal patch of a combined composition based on choline alfoscerate and ethylmethylhydroxypyridine succinate (mexidol) was performed on an Erweca DT700 paddle mixer (blade rotation speed 100 rpm, temperature 32±0.5°C). The quantitative content of ethylmethylhydroxypyridine succinate in the dissolution medium was analyzed using an SF-2000-02 spectrophotometer. A Carbosil dialysis film was used as a semi-permeable membrane. The dissolution medium is an isotonic 0.9% sodium chloride solution. 600 ml of pre-thermostated dissolution medium was placed in each of the 6 vessels of the paddle mixer. Transdermal patches with an area of 25 cm² were placed in bags made of semi-permeable dialysis film of the Kuprofan brand, preventing the formation of folds, and attached to the blades of the agitators using adhesive tape (the contact area of the patches with the dissolution medium was 25 cm²). Stirrers with 2-3mm patches attached to the stirrers were lowered into the vessels in the dissolution medium. The test was carried out according to the requirements of the OFS "Dissolution for transdermal patches" [2]. A similar test was performed with control samples of patches that did not contain mexidol. Sampling was carried out after 0.5, 2, 4 and 24 hours of the experiment. Statistical processing of the obtained results of the analytical methodology of the experiment was carried out. Results. The experimental results indicate a prolonged release of ethylmethylhydroxypyridine succinate (mexidol) during 24 hours of the experiment from the outer layer of the transdermal patch of the combined composition designed by the authors: the degree of mexidol release after 30 minutes of the experiment was 6.52%, after 2 hours - 11.24%, after 4 hours - 26.52%, after 24 hours of observation - 78.88%, while the rate of release of ethylmethylhydroxypyridine succinate gradually decreases during the 24 hours of the experiment. Conclusion. Thus, as a result of biopharmaceutical studies of the combined composition of a transdermal patch with choline alphascerate and ethylmethylhydroxypyridine succinate (50 mg) developed by the authors, a "Dissolution" test method was proposed. The method provides an opportunity to investigate both the amount, degree, and rate of release of drugs from the controlled release formulation, and the stability of the drug during storage.
Key words: трансдермальный пластырь, испытание «Растворение», скорость высвобождения, холина альфосцерат, этилметилгидроксипиридина сукцинат
STUDY OF THE COMPOSITION AND QUANTITATIVE CONTENT OF AMINO ACIDS AND ORGANIC ACIDS OF MAIDEN GRAPE LEAVES
Evsikov F.D., Gudkova A.A.
UDC: 615.074
Abstract: Objective. The aim of the study was to investigate composition and quantitative content of amino acids and organic acids of maiden grape leaves. Methods. The sum of organic acids in terms of malic acid was determined according to the method presented in PA.2.5.0093 "Ryabiny obyknovennoi plody". The amount of free amino acids in the raw material of maiden grape leaves was assessed by spectrophotometry in terms of glutamic acid, according to a method developed by scientists from the Perm State Pharmaceutical Academy. The component composition of the amino acid and organic acid profile was determined using capillary electrophoresis on a device «Kapel'-105/105M» («Lyumeks », Saint Petersburg, Russia). Results. The content of the sum of organic acids in terms of malic acid and the sum of amino acids in terms of glutamic acid in maiden grape leaves of different vegetation phases was determined. It was shown that the greatest amount of the sum of organic acids is characteristic of plant materials harvested in the phase of wilting and reddening of leaves (4.58±0.101%), while the maximum amount of the sum of amino acids is observed for leaves harvested at the beginning of vegetation (3.76±0.174%). According to the results of the study, it is recommended to recalculate the quantitative content of the sum of organic acids to acetic acid. The method of capillary electrophoresis shows that the main components in the profile of organic acids are acetic, propionic and oxalic acids. Acetic and lactic acids are more typical for leaves harvested in the early vegetation phase 1.35% and 0.06%, respectively, and propionic and oxalic acids in withering and reddening leaves 0.18 and 0.068%, respectively. The main components in the amino acid profile have been found to be arginine and glutamic acid. The amount of glutamic acid reaches 0.82% and 0.02%, and the content of arginine was 0.2% and 0.16% at the beginning of vegetation and in the phase of withering and reddening of leaves, respectively. Conclusion. The study of organic acids and amino acids of maiden grape leaves has been conducted for the first time. Based on the results obtained, the phase of reddening and wilting of leaves can be recommended for industrial procurement of plant materials, according to the data on the content of organic acids. For inclusion in the regulatory documentation for maiden grape leaves, the indicator "Content of the sum of organic acids in terms of acetic" of at least 2% can be recommended as well.
Key words: винограда девичьего листья, органические кислоты, аминокислоты, титриметрия, спектрофотометрия, капиллярный электрофорез
COMPARATIVE STUDY OF ANTIFUNGAL ACTIVITY OF WATER-ALCOHOL EXTRACTS OF THE LEAVES OF GENUS SALVIA L
Egorov N.P., Ryzhov V.M., Kurkin V.A., Lyamin A.V., Kozlov A.V., Korchikov E.S., Ruzaeva I.V., Razno S.A.
UDC: 615.32
Abstract: Objective. Our study was aimed at screening of antifungal activity of water-alcohol extracts from the leaves of Salvia officinalis L., Salvia verticillata L. and Salvia nemorosa L. Methods. Assessment of the minimum inhibitory concentration was carried out by the method of double serial exploration in a Muller-Hitton nutrient broth (Bio-Rad, USA). Aspergillus fumigatus (ATS 60654), Aspergillus flavus (ATS 26938), Aspergillus niger (AT 6275), Scopulariopsis brevicaulis (ATS 36840), and Mucor mucedo (ATCC 9635) strains were used as test cultures. Incubation was carried out at a temperature of 35 ° C for 24 hours. The studied samples are water-alcohol extracts from the leaves of Salvia officinalis L., Salvia verticillata L. and Salvia nemorosa L., made using 70%, 96% ethyl alcohol in the ratio "raw material - extractant" (1:50). Results. A comparative study of the antifungal activity in vitro of experimental water-alcohol extracts from the leaves of S. officinalis L., S. verticillata L. and S. nemorosa L. was performed. The method demonstrated antifungal activity of extracts of the studied species in 70% ethyl alcohol against fungal strains - A. flavus, A. fumigatus, A. niger, S. brevicalius. The samples of extracts from the leaves of the studied species of the genus Salvia L. on 70% ethyl alcohol had higher antifungal activity compared with 70% ethyl alcohol, as well as with antifungal comparison drugs. The extracts of S. officinalis L. in 70% ethyl alcohol had the highest antifungal activity against A. flavus, A. fumigatus, A. niger, S. brevicalius, the extracts of leaves of the studied species of the genus Salvia L. on 96% ethyl alcohol showed insignificant antifungal activity against all strains tested. The fungicidal activity was comparable to the antifungal effect of the extractant - 96% ethyl alcohol. Conclusion. The results obtained during the study can serve as a basis for the preparation of a draft pharmacopoeial article for a new dosage form - "Tincture of Salvia officinalis L. leaves", as well as for the further introduction of an innovative antifungal drug into medical and pharmaceutical practice.
Key words: шалфей, Salvia L, листья, противогрибковость, антимикотический эффект, Aspergillus, Scopulariopsis, Mucor
PHYTOCHEMICAL COMPOSITION OF THE LEAVES OF THE DEWBERRY GROWING ON THE TERRITORY OF THE REPUBLIC OF BELARUS
Kasianiuk A.Yu., Mushkina V.W.
UDC: 582.639.123
Abstract: Objective. The aim of the study was to investigate chemical composition of dewberry leaves and develop methods for quantitative analysis of biologically active substances in this raw material. Methods. The study involved dewberry leaves harvested in the Brest and Minsk regions of the Republic of Belarus between 2016 and 2025. The chemical composition was analyzed using thin-layer chromatography, high-performance liquid chromatography, and electron probe analysis. Results. Thin-layer chromatography identified rutin, hyperoside, and chlorogenic acid in dewberry leaves. High-performance liquid chromatography detected hyperoside, chlorogenic acid, caffeic acid, and ellagic acid in dewberry leaf extracts. Quantitative analysis of flavonoids expressed as hyperoside revealed that dewberry leaves contain between 0.54% and 2.09% hyperoside and between 1.94% and 7.27% total flavonoids expressed as hyperoside. Electron probe analysis of dewberry leaves revealed C, O, Mg, Si, P, S, Cl, K, Ca, Mn, and Al. Conclusion. Flavonoids represent the main group of biologically active substances in dewberry leaves. The method for the quantitative determination of flavonoids in dewberry leaves using high-performance liquid chromatography has been developed and validated. Hyperoside is the primary analytical marker.
Key words: листья ежевики сизой, химический состав, тонкослойная хроматография, высокоэффективная жидкостная хроматография, флавоноиды
STUDY OF PECULIARITIES OF ACCUMULATION OF FLAVONOIDS IN THE LEAVES OF SOME SPECIES OF THE GENUS CRATAEGUS
Kurkin V.A., Andreeva Yu.A., Pravdivtseva O.E., Kurkina A.V., Dubishchev A.V., Zhdanova A.V., Avvakumova N.P., Egorova S.N.
UDC: 615.322: 547.972
Abstract: Objective. The aim of the study was to perform comparative pharmacognostic study of the leaves of Crataegus sanguinea Pall. and Crataegus flabellata (Bosc ex Spach) K.Koch) harvested in the period from May to August. Methods. Morphological and anatomical study of the leaves of Crataegus sanguinea Pall. and Crataegus flabellata (Bosc ex Spach) K.Koch) was carried out. The study of qualitative analysis was carried out by thin-layer chromatography by determining the main group of active substances, flavonoids, using differential spectrophotometry. Resuits. Morphological and anatomical analysis showed no distinguishing features for hawthorn leaves harvested in different months of the growing season. At the same time, it was found that the method of thin-layer chromatography and UV spectrophotometry makes it possible to reliably distinguish the leaves of Crataegus sanguinea Pall. and Crataegus flabellata (Bosc ex Spach) K.Koch) collected in May from the leaves harvested in the summer. Therefore, these methods can serve to determine the authenticity of the raw materials under study. The highest content of the total flavonoids calculated on vitexin 2II-O-rhamnoside is also typical for May samples of Crataegus sanguinea Pall. and Crataegus flabellata (Bosc ex Spach) K.Koch) leaves (4.11±0.21% and 5.72±0.29%, respectively). Conclusion. The leaves of Crataegus sanguinea Pall. and Crataegus flabellata (Bosc ex Spach) K.Koch) can be used as medicinal plant raw materials.
Key words: Crataegus sanguinea Pall, Crataegus flabellatа (Bosc ex Spach) K.Koch, листья, флавоноиды, тонкослойная хроматография, спектрофотометрия
CURRENT STATE OF THE PHARMACEUTICAL MARKET OF DRUGS FOR THE TREATMENT AND PREVENTION OF OUT-OF-HOSPITAL PNEUMONIA
Muravyev A.A., Krikova A.V., Alekseeva V.A.
UDC: 616-08-031.81
Abstract: Objective. The aim of the sudy was to perform comprehensive assessment of the pharmaceutical market for medicinal products used for the treatment and prevention of community-acquired pneumonia (CAP) in the Russian Federation. Materials and methods. A content analysis of regulatory and legal documentation and data from the State Register of Medicines (2024) was conducted, along with evaluation of medicinal products and vaccines registered and approved for medical use in the Russian Federation. The range and prices of medicines for the treatment of CAP were analyzed using data from online pharmacies in Smolensk (https://apteka.ru/smolensk/, https://www.eapteka.ru/smolensk) in January-February, 2025. Descriptive statistical methods and selected elements of marketing analysis were applied. Results. Pneumococcal infection remains a major global public health threat. Streptococcus pneumoniae continues to be the leading etiological agent of community-acquired pneumonia, causing a broad spectrum of diseases in both children and adults, including severe and complicated forms. This underscores the importance of developing and optimizing effective preventive and therapeutic strategies. Pharmaceutical market in Russian offers a wide range of antibacterial agents for the treatment of CAP, represented by various pharmacotherapeutic classes and dosage forms, providing clinicians and patients with an extensive choice of therapeutic options. In both outpatient and inpatient practice, first-line drugs include penicillins and their combinations with β-lactamase inhibitors; in cases of inefficacy or hypersensitivity, macrolides or second- and third-generation cephalosporins are used. In recent years, the number of newly introduced antibacterial agents has been steadily increasing, expanding the therapeutic possibilities available to physicians. Conclusion. Most medicines for the treatment of community-acquired pneumonia are manufactured by domestic pharmaceutical companies, contributing to market stability and reducing dependence on foreign manufacturers. Three pneumococcal vaccines are currently registered and approved for use in the Russian Federation.
Key words: фармацевтический рынок, внебольничная пневмония, антибактериальная терапия, Streptococcus pneumoniae, вакцины
QUALITATIVE ANALYSIS OF THE RUSSIAN PHARMACEUTICAL INSULIN MARKET
Chukarina Yu.V., Perederii E.A.
UDC: 615.272.3:316.334.2
Abstract: Objective. The study was aimed at qualitative content analysis of insulins and their substances registered on the Russian pharmaceutical market, with further construction of the macro-contour of the market of the studied group. Methods. The study included international nonproprietary and trade names of insulins and their substances included in the State Register of Medicines, clinical recommendations for the treatment of type 1 and type 2 diabetes mellitus, the List of Essential and Essential Medicines (VED), and the Standard List of Essential Medicines of the World Health Organization (WHO) (as of May 2025). Methods of analysis: marketing, graphic, statistical and content analysis. Results. Nowadays, 13 international nonproprietary names (INN) of insulin preparations have been identified in clinical guidelines, of which 38.46% were fast-acting drugs, 7.69% were medium-acting drugs, 23.08% were long-acting drugs and 30.77% were combined drugs. The WHO Standard List defines only 5 names of insulin as the main drugs, while the List of VED contains 13 INN. In total, 24 manufacturers of the insulin substance are registered in the Russian Federation, which produce 7 INN. In total, 17 INN and 78 trade names (TN) (57.69% is produced in the Russian Federation) of drugs from the study group and their combinations with other insulins and synthetic hypoglycemic drugs have been identified on the pharmaceutical market. Conclusions. Conducted qualitative content analysis indicates the predominance of the share of domestic drugs, however, some INN are represented exclusively by imported drugs. Russia demonstrates a leadership position in the production of pharmaceutical insulin substances in comparison with other import countries.
Key words: качественный контент-анализ, инсулины, фармацевтический рынок, маркетинговое исследование
MARKETING ASSESSMENT OF THE POTENTIAL OF INTRODUCING NEW DENTAL MEDICINES USING THE PHARMACEUTICAL MARKET OF THE SVERDLOVSK REGION AS AN EXAMPLE
Petrov A.L., Chirkova O.N., Petrova N.N., Andrianova G.N., Gavrilov A.S.
UDC: 615.15
Abstract: Objective. The aim of the study was to conduct a marketing assessment of specific assortment segments of dental medicines in order to justify the feasibility of introducing new industrially manufactured dental medicinal products as well as extemporaneous formulations into the compounding departments of pharmacy organizations. Methods. Structural analysis of dental medicinal products was carried out using data from the State Register of Medicinal Products (GRLS) and the actual assortment of the regional pharmacy network. The assortment was divided into three characteristic segments according to the extension of therapeutic application. For each segment, a marketing analysis was performed based on key economic indicators, including sales volume in physical and monetary terms and margin levels; a structural margin indicator was also calculated. Results. It was established that specialized dental medicinal products were characterized by a wide variety of dosage forms, yet they ensure a smaller sales volume. Their weighted average margin (26.29%) was comparable to the average margin of medicinal products in the Russian pharmaceutical market. The non-specific segment of antiseptics and disinfectants consists predominantly of generic products, demonstrates higher sales volumes, and provides high margin levels despite lower technological variability. Conclusion. A disproportion was identified between the level of technological complexity and financial performance, resulting in limited incentives for the development of innovative solutions under conditions of prevailing demand for universal medicinal products with minimal technological variability. The priority direction for expanding the assortment is an introduction of innovative dental medicinal products, both through industrial manufacturing and by extemporaneous compounding within pharmacy organizations.
Key words: стоматологические препараты, антисептики, ассортимент, маржинальность, лекарственные формы, маркетинговый анализ
CHEMICAL SUBSTANTIATION OF POLYURONIDES AS LEAD (II) ION DETOXIFIERS BY THE CURVE INTERSECTION METHOD
Kajsheva N.Sh.
UDC: 615.1
Abstract: Objective. The aim of the study was to identify composition and stability of soluble products of the interaction of sodium alginate and pectin with lead(II) and manganese(II) ions (metal polyuronates) to substantiate the potential use of polyuronides as promising detoxifiers for toxic metals. Methods. Complexonometry was used as an analytical method, and the curve intersection method was used for calculations. Results. Formation of products of varying composition (based on the polyuronide monomer) in solution has been identified: 1:1, 1:2, and 1:3, indicating stepwise complexation. Polyuronides bind lead(II) ions more strongly than manganese(II) ions (a difference of 11-31 orders of magnitude). Therefore, toxic lead(II) ions are more competitive for polyuronides than biogenic manganese(II) ions. Moreover, polyuronide complexes with manganese(II) ions are weaker (by 4-24 orders of magnitude) than amino acids, nucleotides, and enzymes with the same ions in vivo, making it impossible for polyuronides to destroy biological complexes. Conclusion. Relatively high binding efficiency of alginates and pectins for toxic metal ions, coupled with their low selectivity for biogenic metals and other polyuronide effects (biological availability, influence on biological oxidation processes, antihypoxic, antioxidant, membrane-stabilizing, anabolic, and antitoxic effects, and the ability to accelerate intestinal evacuation) make polyuronides superior antidotes compared to known detoxifiers.
Key words: альгинаты, пектинаты, ионы металлов (II), комплексы
DEVELOPMENT OF A HEALTH-PROMOTING EDUCATIONAL ENVIRONMENT AND AN EARLY CAREER ORIENTATION SYSTEM AS AN INNOVATIVE MODEL FOR TRAINING MEDICAL PERSONNEL (BASED ON THE EXAMPLE OF THE PROJECT «FIRST-YEAR STUDENT'S HEALTH - DOCTOR’S HEALTH - NATION'S HEALTH!» IMPLEMENTED AT SMOLENSK STATE MEDICAL UNIVERSITY)
Kozlov R.S., Kozhurina A.A., Krikova A.V., Dmitrieva E.V., Shashmurina V.R., Mishutina O.L., Zaitseva V.M., Tsareva V.M., Ulasen' T.V.
UDC: 378.66:614.25
Abstract: Objective. The aim of the study was to present the results of a five-year period of a University project aimed at creating a health saving educational environment and an early career orientation system, demonstrating the achievement of synergistic effect in terms of the national targets of improving public health and providing healthcare with qualified personnel. Methods. The project has been implemented based on a three-level concept of health (individual, professional and community levels) utilizing a systemic approach that integrates education, science and clinical practice. Results. The University team has developed an innovative model of health saving educational environment. The project covered over 3,500 students within the period from 2020 to 2025. Twenty-eight preventive campaigns have been organized in ten municipal districts of Smolensk region with involvement of more than 160 clinical residents and students. Groups for the risk of myopia, osteoporosis, arterial hypertension, dental diseases, and gynecological disorders development have been identified. A unified "Health Passport" has been introduced for personalized monitoring. The Resource Center has been set up as a multifunctional platform for developing professional competencies. Conclusion. The University's project and its results confirm effectiveness of a holistic approach to innovation in medical education and demonstrates considerable potential for scaling the model to other medical universities all over the country.
Key words: инновационная образовательная среда, здоровьесбережение, профориентация, профессиональные компетенции, медицинское образование, кадровое обеспечение
A WORD ABOUT OUR TEACHERS - 20 YEARS LATER
AGAFONOV O.I., AZEEVA E.S., ALEKSEEVA L.N., ATYUNINA I.V., BELOUS O.V., GORYAINOV S.A., ZLENKO A.E., KOROLEV P.V., SIDOROVA Yu.A., SIDOROV V.V.
UDC: 378.66:614.25
Abstract: Dedicated to the 20th anniversary of the graduation (2006) of former students of the 1st "A" group of the medical faculty of the Smolensk State Medical University (Academy)
Key words: юбилей, выпуск, 20-летие