Vol 19, No 4 (2022)

The article presents the data of the analysis of modern data on the efficacy and safety of genetically engineered biological drugs registered in the Russian Federation for the treatment of moderately severe and severe forms of psoriasis. The review of modern domestic and foreign literature showed a higher efficacy and safety of biological preparations compared with basic anti-inflammatory therapy and the expediency of prescribing TNF-a inhibitors, IL-12/23, IL-17, IL-23 inhibitors in various forms of psoriasis, given the degree severity and comorbid conditions. This review will help practitioners to determine the most optimal treatment regimen for moderately severe and severe forms of psoriasis.

Helicobacter pylori infection remains the leading cause of a number of gastroduodenal diseases. Although various eradication regimens are used to reduce associated morbidity and mortality, the prevalence of this bacterial infection is still disproportionately high worldwide, mainly due to antibiotic resistance. In these conditions, it is very important to strictly follow the basic recommendations for choosing an eradication therapy scheme. This article provides an overview of current Russian and international consensus guidelines and recommendations for the treatment of helicobacter infection. The results of various studies, including our own, are presented to assess the compliance of real practice in the management of patients with Helicobacter pylori infection with current clinical recommendations.

The preservation of reproductive function in women with purulent-inflammatory complications after cesarean section, in particular, peritonitis, is an extremely difficult task due to the risk of generalization of infection. At the same time, for many young women, such an outcome of childbirth threatens not only with deterioration of health in the near and long term future, but also serious social problems. It should be noted that performing organ-preserving operations for purulent-inflammatory complications and divergence of the suture on the uterus after cesarean section is a little-studied, but promising problem, as evidenced by the materials of the literature review.

Resume. Purpose: to assess the state of the macular region of the retina using the study of autofluorescence (AF) of the eye fundus in young subjects with high visual acuity and different types of clinical refraction. Material and methods. 104 healthy volunteers (208 eyes), 70 females and 34 males, aged 20 to 30 years, average age (24,5 ± 0,4) года у.о., were examined. All patients had high visual acuity (1,0 and higher) and there were no signs of pathology in the macular region, which was established ophthalmoscopicaUy and confirmed by optical coherence tomography (OCT) data. Such methods of the examination were performed in all subjects as visometry with correction, refractometry, ophthalmobiomi-ocroscopy with Goldmann's lens, OCT in the 3D mode of the macular region of the fundus and the study of fundus-AF with typing on known patterns: normal pattern, minimal changes, focal changes and reticular pattern. The analysis was carried out in 10 subgroups depending on the type, the degree of clinical refraction and the presence of astigmatism. Results. 4 main patterns of AF were identified in the examined subjects: normal, minimal changes, focal changes and reticular. The most common pattern in all refractive groups was the reticular pattern, the frequency of which ranged from 41,7 to 88,9 %. The least common pattern was normal, the frequency of which ranged from 4,2 to 33,3 %. A significant difference between the values of the thickness of the retina in the foveal zone with the reticular pattern and its average group value in different refractive groups was not found. Conclusion. In young subjects with high visual acuity without clinical manifestation of pathology of the macular zone, AF-patterns other than the normal picture may be present. The reticular pattern is noted as the most common in all analyzed groups with various types of refraction. Further studies of early changes in fundus AF may make it possible to determine the predictors of the development of dystrophic pathology of the macular zone.

Resume. The purpose of the work was to identify patterns of adaptation of young people to new environmental conditions when changing their place of residence. The study was carried out from September 2021 to June 2022, with the participation of 134 people, 32 men and 102 women aged 18-20, first-year students of state universities in Volgograd. The gender, age, place of birth and place of residence of the respondents before entering the university were taken into account. To assess the level of systemic maladjustment, in terms of psychological, psychophysiological and psychosomatic symptoms of extreme tension of the body, a blank test by I.N. Gurvich, developed at the Psychoneurological Research Institute. V.M. Ankylosing spondylitis in 1992. Manifestations of a stress reaction (Giessen questionnaire of somatic complaints) and anxiety-depressive disorders (HADS scale) were taken into account, and the presence of suicidal ideation was determined - modulo suicidal ideas of the Columbian Suicidal Seriousness Scale (C-SSRS). The functional status, in relation to the stress resistance of the subjects, was assessed by the level of the general nonspecific reactivity of the organism. As a result of the studies performed, it was determined that the maximum development of systemic maladjustment, at the time of passing the second examination session, is characteristic of male students who arrived to study in Volgograd from other regions of Russia. Throughout the spectrum of the studied symptoms of disa-daptation, both in the somatic (headaches, pains in the stomach, heart, abdomen) and in the mental (insomnia, physical fatigue, depression, suicidal ideation) sphere, their prevalence in groups of non-indigenous students is characteristic. residents of the Volgograd region, which is especially pronounced in men. In addition, male students, representatives of other regions of Russia are characterized by a high level of general non-specific reactivity, indicating their low stress resistance, and men -the natives of the Volgograd region, in general, are characterized by an average level of general non-specific reactivity of the organism. Women - participants in the study, both indigenous and non-indigenous residents of the Volgograd region, are characterized by a high level of non-specific reactivity, which implies an increased stress reactivity of the body, and, accordingly, a risk of systemic maladaptation.

Resume. Aim. Glaucoma is a whole group of diseases caused by increased intraocular pressure (IOP), leading to atrophy of the optic nerve and irreversible blindness. Melatonin has a wide range of biological activity, including antioxidant and antiglaucoma, but its use is limited by insufficient stability and duration of action. To search for new, more effective antiglaucoma agents among derivatives of 3-arylidene-2-oxindole, melatonin analogues, a search for quinonoxidoreductase 2 (NQO2) inhibitors was performed, antioxidant activity was determined and the effect of active compounds on intraocular pressure was studied. Materials and methods. The study of inhibitory activity against NQO2 was evaluated kinetically using menadione and N-benzyl-dihydronicotinamide as substrate and co-substrate, respectively. Antiradical activity was studied for reducing superoxide-dependent luminescence in a reaction medium containing hemoglobin, luminol and hydrogen peroxide using the Infinite M200 PRO microplate reader (Tecan, Austria), as well as for free radical binding tests OH, ABTS and DPPH. Cytotoxicity assessment was carried out using a standard MTT test on MCF-7 and HepG2 line cells. Intraocular pressure in laboratory animals was measured using a contact veterinary tonometer Tonovet (Finland). Results. Derivatives of 3-arylidene-2-oxindole have demonstrated significant antioxidant activity. A number of NQO2 inhibitors have also been identified. The most active compound inhibits human NQO2 with an IC50 of 0,4 pM. The compound also showed antiradical activity, binding the superoxide anion to IC50 of 6,1 pM, superior to melatonin on both counts, and low cytotoxicity. With topical application of a 0,4% solution, the compound reduced the intraocular pressure of intact rats by (40,9 ± 6,4) %, while not having a systemic hypotensive effect. Conclusion. Derivatives of 3-arylidene-2-oxindole are promising for drug discovery for the treatment of eye diseases associated with increased intraocular pressure or oxidative stress, such as glaucoma, uveitis and diabetic retinopathy.

On the model of premature aging induced by 30-day dark deprivation (light-dark cycle 24/0 h, artificial illumination 300 Lux), the effect of exogenous melatonin (0.3 mg/kg, 14 days after the cancellation of dark deprivation, intragastric daily in 2 % starch mucus) on the dynamics of body weight and the level of Klotho protein in the blood was studied in outbred white male rats of 4 months of age. It has been shown that prolonged dark deprivation is accompanied by a statistically significant decrease in the content of the Klotho protein in the blood serum, which is a marker of premature aging. Metabolic disorders associated with a statistically significant decrease in the level of melatonin and Klotho protein in the blood were expressed in fLuctuations in the dynamics and rate of body weight gain in animaLs. At the same time, exogenous meLatonin had a protective effect on the condition of animals - it contributed to an increase in the content of Klotho protein in the blood serum and restored the level of melatonin to the values of the negative control indicator.

The rapid development of technology has a significant impact on the daily life of a person. Light, sound, information pollution leads to sleep disturbance, which has a negative impact on the physical condition. Even short-term sleep disturbance caused by dark deprivation Leads to a decrease in serum testosterone LeveLs. The imbaLance of maLe sex hormones, the synthesis of which is under the controL of the hypothaLamic-pituitary system, negativeLy affects the morphofunctionaL state of the testes. The effect of exogenous meLatonin on the morphoLogicaL and functionaL state of the spermatogenic epitheLium of the testes, Leydig cells in white outbred male rats of 4 months of age was studied on the model of premature aging caused by 30-day dark deprivation, and the KLotho protein LeveL in bLood serum was assessed by enzyme immunoassay. It was found that the morphoLogicaL changes in the testes were characterized by a decrease in the thickness of the spermatogenic epithelium by 30 days after dark deprivation and a decrease in the LeveL of the KLotho protein, which is a marker of premature aging. The introduction of exogenous meLatonin had a protective effect on the morphoLogicaL and functionaL status of the testes of animaLs, accompanied by the restoration of the spermatogenic epitheLium, an increase in the KLotho protein to the LeveL of the negative controL group.

Aim. To study the influence of systemic disorders on the risk of developing pancreatogenic encephalopathy. Materials and methods. In the period from 2010 to 2020, a prospective non-randomized cohort study was conducted at the clinical base of Department of Faculty Surgery of Volgograd State Medical University. ROC analysis was used to determine the impact of systemic disorders on the risk of developing pancreatogenic encephalopathy (PEP). The influence of the pancreatic necrosis trigger on the risk of multiple organ failure syndrome (MOF) was determined using logistic regression analysis. Results. The study included 429 patients with acute destructive pancreatitis. It was revealed that the debut of systemic disorders occurred on average on the first day of hospitalization. The most common were intestinal and cardiovascular insufficiency - 336 (78,3 %) and 242 (56,4 %) cases, respectively. In patients with alcohol-associated pancreatic necrosis (AAPN), intestinal failure was significantly more common [144 (84,7 %) versus 192 (74,1 %), OR = 1,93, CI 1,164-3,210, p = 0,012] and multiple systemic disorders [159 (93,5 %) versus 224 (86,5 %), OR = 1,18, CI 0,659-2,122, p = 0,025] than in patients with non-alcoholic pancreatic necrosis (NAPN). The conducted logistic regression analysis proved an increased risk of PEP in the presence of any organ dysfunction. However, no such relationship was found for acute renal failure. The risk of developing MODS in patients with AAPN increases by 37,5 % compared with patients with non-alcoholic pancreatic necrosis, while the specificity and sensitivity reach 75,3 % and 70,0 %, respectively. Conclusions. In patients with alcoholic genesis of pancreatic necrosis, the risk of intestinal failure, as well as multiple systemic disorders, significantly increases. A significant increase in the likelihood of organ and multiorgan disorders in patients with pancreatogenic encephalopathy was revealed.

The effect of a new conjugate of hydroxybenzoic acid with glycine on sensory-motor and cognitive impairments in experimental animals with chronic cerebrovascular insufficiency (CCI) was studied. CCI was modeled in rats by stenosis of the lumen of the carotid arteries in 60 %. 40 days after the operation, experimental groups were formed and the test compound was administered for 14 days. Citicoline was used as a reference drug, and saline was administered as placebo. After treatment with the Rotarod, Adhesion Test, Novel Object Recognition (NOR), and Morris Water Maze tests, the severity of sensory-motor and cognitive impairments was assessed. It was noted that in animals with CCI with placebo treatment, the pathology was accompanied by a pronounced impairment of coordination and sensory-motor function of the forelimbs, as well as cognitive impairments (impaired short-term and long-term memory in the NOR and the Morris maze tests). The course introduction of a new conjugate of hydroxybenzoic acid with glycine contributed to a significant improvement in sensory-motor and cognitive functions in animals with CCI. The noted neuroprotective effect was comparable to that of the reference drug citicoline.

Affiliation. Federal state budgetary educational institution of higher education «North-Western State Medical University named after I. I. Mechnikov» under the Ministry of Health of the Russian Federation, Saint-Petersburg Introduction. Elevated level of transforming growth factor-61 (TGF-61) can be the cause of impaired immune response among women with endometriosis due to its ability to reduce the activity of NK-cells, which contributes to the survival of ectopic endometrial cells in the abdominal cavity and plays a key role in the progression of the disease. Materials and methods. 196 endometrioma observations were studied, an immunological study of peripheral blood was performed with the determination of CD3-CD16/56+ (natural killers) and an IHC study of the expression of TGF-61 in the capsule of an endometrioid cyst and in a preserved cytogenic stroma. The IHC study showed that the expression area of TGF-61 was significantly larger in the surgical material in the recurrent course of endometriosis; an immunological study revealed a significant decrease in NKcells during the endo-metrioma recurrence. Conclusion: Further study of the relationship between TGF-61 and NK cells may be important as prognostic markers of recurrent endometriosis.

Worldwide, fetal growth restriction (FGR) is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Ongoing advances in clinical care, especially in definitions, diagnosis, and management of FGR, require efforts to effectively translate these changes to the wide range of obstetric care providers. This article highlights agreements based on current research in the diagnosis and management of FGR. The purpose of this article is to provide a comprehensive summary of available evidence along with practical recommendations concerning the care of pregnancies at risk of or complicated by FGR, with the overall goal to decrease the risk of stillbirth and neonatal mortality and morbidity associated with this condition. This article is directed at multiple stakeholders, including healthcare providers, healthcare delivery organizations and providers, FIGO member societies, and professional organizations. Aspects of FGR addressed in this article include prediction, diagnosis, investigation, and management.