Vol 31, No 1 (2020)

Bronchial asthma (BA) is a common and socially significant disease. In according to the WHO’s data, the incidence of bronchial asthma is growing steadily, there are about 300 million people with BA disease in the world now. So, its prevention is an urgent task of medicine. Our review is devoted to the modern ideas ofthe intestinal microbiota role in the pathogenesis of bronchial asthma. Nowadays, there is a strong evidence of the interaction between the intestinal microbiota and the respiratory tract through the gut-lung axis.Factors influence on the intestinal microbiota composition are discussed, including the composition of the maternal microbiota, the childbirth method , the child feeding method, the drugs prescription and an influence of the environmental factors also.It was analyzed of the results of experimental and clinical studies, which have confirmed the influence of intestinal microflora on the development and progression of the disease. It was established the composition violation and metabolic activity of the microbiota contributed to the polarization of the immune response towards T type 2 helper cells. At the same time, the high biological diversity of intestinal microorganisms contributes to the adequate bacterial metabolites production, inducing the immune regulatory pathways and contributes to the anti-inflammatory response. We have reviewed the main possible molecular mechanisms due to which symbiont bacteria prevent the development of BA. The results of clinical studies on reducing the risk of BA disease, the duration and severity of BA symptoms with probiotics, as for childhood as for the adult population, are presented in the review.

A steady world population aging and the global problem of increasing the incidence of vascular dementia, including Alzheimer’s disease, contribute to the development of sociomedical approaches and scientifically based technologies aimed at preventing premature aging. The nutrition and health evidence base is the basis for an interdisciplinary consensus on premature aging. Adequate nutrition obtained through the use of a variety of foods from all food groups improves metabolic processes, by achieving immunomodulating, antioxidant, and other beneficial effects, and optimizes adaptation to age-related physiological changes in the aging body. The anti-atherosclerotic and anti-osteoporotic metabolic orientation of the diet substantially affects the rate of both premature and physiological aging. Time is a key factor in the efficiency of preventive therapy. A personalized approach to determining the pattern and frequency of food intake, the amount of consumed foods and biologically active substances, as well as healthy eating behavior that considers nutrition as a powerful potential of natural factors (antioxidants, bioelements, prebiotics (dietary fiber), probiotics, and other compounds) contributes to the correction of oxidative stress, the reduction of depletion of cardiovascular system reserves, and the activation of brain-derived neurotrophic factor. Geroprotective nutrition opens up prospects for healthy aging and improves quality of life.

Patients with granulosa cell tumors need for lifelong follow-up, the main goal of which is an early preclinical diagnosis of recurrences. In addition, at all stages of recovery, a woman need the help of specialists of different profiles (a multidisciplinary team) to draw up and implement a rehabilitation plan, by taking into account the age and status of the patient, as well as the performed treatment volume. An analytical scientific and medical literature review suggests that many issues relating to the recovery and monitoring of patients after antitumor therapy have been studied insufficiently and the available data are contradictory and ambiguous. Therefore, it is necessary to develop and put into practice new, effective rehabilitation methods, to implement an individual and integrated approach to each woman, to consider current algorithms, and to apply the most appropriate management strategy for gynecological cancer patients.

HIV-infection is the most powerful of the medical factors that provoke the development of tuberculosis. Tuberculosis and AIDS are considered as natural companions. The regularity of this phenomenon is explained, first of all, by the predominant distribution of these diseases among the same population groups in terms of social risk factors and the characteristics of the immune mechanisms of the disease. The situation is complicated by the fact that the Russian Federation is one of the countries with high rates of HIV-infection. A review of foreign and domestic literature data on current features of the epidemiology, risk factors and causes of death in patients with comorbidity of tuberculosis and HIV-infection (TB/HIV) is presented. The problem of TB/HIV has a high social orientation, a significant risk factor for the development of the disease and a death factor is the consumption of narcotic substances. In recent years the situation has been complicated by an increase in the sexual transmission of HIV-infection, and the number of infected among young women is growing. The high susceptibility of HIV/AIDS patients to Mycobacterium tuberculosis is unique and creates many difficulties in terms of diagnosis and treatment. Tuberculosis (TB) can develop in any phase of the course of HIV-infection, but it is TB who is 1-3 months ahead other AIDS-associated opportunistic infections. In the ongoing studies difficulties are noted in the early recognition of tuberculosis occurring against AIDS due to the similarity of the clinical symptoms of these two diseases. In all studies low diagnostic information content is noted, which complicates the diagnosis of TB. All authors report the cause of death as the late detection of diseases, the detection of tuberculosis during the AIDS stage, low adherence to antiretroviral therapy, and breaks from treatment. All authors conclude that urgent measures are needed to improve tuberculosis control for patients living with HIV-infection. An important role is given to the early detection of the disease using modern immunological tests. High mortality in TB/HIV patients in Eastern Europe and Russian Federation deserves further study and an interdisciplinary approach to solving the problem, finding new effective ways to prevent and treat comorbid pathology (TB/HIV).

Hybrid minimally invasive surgical treatments are increasingly being used in modern sur-gery. Hybrid partial resection of the stomach has begun to be done since the invention of a special endoscopic instrument. New technical capabilities could resect the stomach wall for a tumor within the intact tissues over the extent along the stomach wall and by the growth depth for therapeutic and diagnostic purposes.

Introductlon. Recently, in the treatment of patients with choledocholithiasis complicated by obstructive jaundice and cholangitis, along with traditional surgical interventions, endoscopic interventions are increasingly used. Purpose. To study the results of endoscopic transpapillary interventions in the treatment of choledocholithiasis. Materlal and methods. Interventions on the large duodenal papilla were performed in 286 patients with obstructive jaundice caused by choledocholiasis. There were 208 women, 78 men, the average age of patients was 64 years old, over 60 years old was 72%. Results. In 255 (87.7%) patients with single and multiple stones of the common bile duct of relatively small diameter (from 0.8 to 1.4 cm), after performing various endoscopic procedures, it was possible to extract calculi into the intestinal lumen. All patients previously performed endoscopic papillotomy, which facilitated the subsequent extraction of stones. The length of the papillotomy incision depended on the severity of the longitudinal fold and did not exceed 6-8 mm. In 55 of the 256 patients, nasobiliary drainage was installed, which made it possible to reduce the effects of obstructive jaundice and stop the phenomena of cholangitis. Concluslon. Nasobiliary drainage and endoprosthetics of the choledochus can improve the condition of patients and prepare for more radical endoscopic and surgical treatment.

Joint hypermobility syndrome (JHS) is perhaps the most common type of connective tissue dysplasia, which frequently occurs with systemic disorders. Postural tachycardia is considered as one of the manifestations of this syndrome. But the clinical interpretation of postural tachycardia requires clarification. Material and methods. We examined 26 children with JHS without a history of syncope (group 1; 11 boys and 15 girls, age 14.27±0.27years) and 26 children without a history of JHS (group 2; 12 boys and 14 girls, age 14.19±0.25years). We separately assessed the dynamics of heart rate in 12 children with JHS and orthostatic syncope(3 boys and 9 girls, age 14.21±0.28 years). Heart rate was determined at a 10-minute horizontal position and immediately after verticalization. JHS was diagnosed according to the criteria of R. Graham et al., M. Simpson, with a score of 4 or higher with other signs of GHS: family history, age, gender, mitral valve prolapse, myopia, skin hyperelasticity, marfanoid status. Results. Groups 1 and 2 by gender and age did not differ. The average age of children in the group with a history of syncope also did not differ from groups 1 and 2, but girls prevailed. Heart rate at rest in all groups was statistically insignificant. However, heart rate after verticalization, in the group with JHS without fainting (90.22±2.67) and with fainting (108.19±8.19), significantly (p<0.0002) exceeded the similar indicators (70.23±1,17) in the control group. Conclusion. In children with JHS, heart rate increased sharply during verticalization, especially in those prone to fainting, which may indicate autonomic dysfunction inherent in connective tissue dysplasia.

Currently, drug-induced liver injury is a significant health problem. These damages are the result of clinical and morphological changes in the liver caused by direct or indirect adverse reaction to drugs and/ or their metabolites. In the Russian Federation alone, about 5 thousands international generic names of medications are registered, and a quarter of them is potentially hepatotoxic. Moreover, the number of drugs is increasing annually and most of them are OTC - available without doctor's prescription. The other, no less important problem is polypharmacy, unreasonable application of multiple medications simultaneously. Thus, current standards of care for a number of diseases require a simultaneous administration of 3-4 groups of medications, and in a polymorbid patient this figure can increase several times. It is important to note that drug administration occurs without a preliminary assessment of liver function, that increases the risk of drug related complications. The clinical manifestations of drug-induced liver injury are nonspecific and expressed to varying degrees. Currently, common standards of care for drug-induced liver injury have not been developed, and in some cases there are no specific antidotes. Therefore, the treatment of drug-induced liver injury, like any other toxic process begins with the discontinuation of the «guilty» drug that caused this disease, as well as the administration of hepatoprotective therapy. In our study, ursodeoxycholic acid is considered as the background therapy of drug-induced liver injury. A special attention is paid to preventive measures as well.

The authors have proposed and justified the principle of treatment for patients with severe head injury and bleeding into to the lateral ventricles of the brain in the presence of hypertensive syndrome, by using the data obtained in 3 compared groups of patients receiving different treatment regimens. The classical regimen has been modified; the treatment has been added by the use of auto-erythrocytes for targeted drug transport. The management tactics and the features of the course of the disease in patients of the above groups are described in detail.

To improve the treatment of venous trophic ulcers, 86 patients with venous trophic ulcers were treated and examined. A vein tonic, sulodexide, antibacterial therapy, antihistamines, and analgesics (for pain) were used as basic treatment.