Vol 7, No 7 (2021)

The frequency of pathology of the musculoskeletal system against the background of inflammatory bowel diseases (IBD) reaches 40%. The aim of the study was to assess the frequency, clinical, biochemical, and radiological features of axial (ankylosing spondylitis) and peripheral arthropathy type I, biochemical markers of bone metabolism disorders, and bone mineral density (BMD) parameters in comparison with the phenotype, clinical features, and morphometric characteristics of CD3-immunopositive colonocytes in patients with Crohn's disease (CD) and ulcerative colitis (UC). Material and methods. The study included 157 patients with UC and 37 patients with CD. In patients with ankylosing spondylitis in IBD, a quantitative assessment of the general state of health was performed using the BASDAI questionnaire, the combined ASDAS index of CRP, and the functional activity of patients using the DFI index. Structural changes in the musculoskeletal system were verified by X-ray examination of the sacroiliac joint, spine, and large joints. To assess the biochemical markers of BMD, the levels of tartrate-resistant acid and alkaline phosphatase, and ionized calcium were determined in the blood serum. Instrumental methods included densitometry with the determination of the T-score. The results of morphometric and immunohistochemical studies were taken into account with the assessment of the quantitative density of CD3-positive colonocytes of the epithelium and the own plate of the colon mucosa. Results and conclusion. Pathology of the musculoskeletal system in IBD was diagnosed in 48,6% of patients with CD and in 14% of patients with UC. Bowel disease debuted as arthropathy in 2,5% of patients with UC and in 13,5% of patients with CD. For peripheral arthropathies of type I on the background of IBD, non-erosive changes in the articular surfaces without joint deformity were characteristic. Osteopenic syndrome was detected in 8,2% of patients. In UC, the risk factors for osteopenia were a recurrent course of the disease with a history of 3-5 years; in CD, terminal ileitis with a history of up to 1 year, a recurrent course. In 3,1% of cases, osteopenia is associated with steroid-dependent forms of IBD. Osteopenic syndrome in IBD was also associated with an increase in the quantitative density of CD3-positive colonocytes in the epithelium and in the selfplate of the colon mucosa. In patients with ankylosing spondylitis on the background of CD, the maximum increase in these parameters was observed.

The aim of the study was to establish the prognostic and diagnostic value of the study of the concentration of lipopolysaccharide - binding protein (LBP) in the blood of patients with liver cirrhosis (LC). Material and methods. The study involved 120 patients with LC of viral, alcoholic and mixed etiology and 30 apparently healthy donors (control group). The studies were carried out during the hospitalization of the patient in the gastroenterological department in the phase of exacerbation of the disease. LBP concentration in blood plasma was determined by enzyme-linked immunosorbent assay. Results. The median values of LBP concentration in LC with a high degree of reliability (p <0.001) was higher than in the control group. The variability of LBP indices in LC ranged from 10,4 ng/ml to 58,3 ng/ ml. The level of protein in the blood plasma was increased compared with the normal ranges in 88% of patients. The increase in LBP concentration did not have significant differences depending on the etiology of LC. An increase in LBP values was significantly associated with disease activity, severity of portal hypertension (PH) and associated syndromes: ascites, chronic hepatic encephalopathy, degree of esophageal varicose veins, increased Child-Pugh gradation, and LC decompensation. A comparative study of the clinical and laboratory characteristics of the disease was carried out in two subgroups of LC patients with the lowest (LBP <30 ng/ml; n=20) and highest (LBP> 45 ng/ml; n=38) protein concentrations. Differences in the compared subgroups had a high degree of statistical significance (p <0,01). It has been shown that in patients with LC, a significant (threefold and higher, compared with the normal ranges) increase in the blood LBP level is associated with a more severe course of the disease, the appearance of endotoxemia and systemic inflammation syndromes, a high risk of developing decompensation of LC, compared with patients with no more than a twofold increase in LBP concentration. Conclusion. The study of LBP concentration in blood in patients with LC can be used to diagnose syndromes of bacterial overgrowth in the intestine, endotoxemia. The detection of a threefold or more increase in the LBP concentration in the blood characterizes the severity of the pathological process in the liver, the severity of PH and associated syndromes, and allows predicting the development of decompensated LC.

The aim: to study the level of the insulin-like growth factor IGF-I in the peripheral blood, to assess bone mineral density (BMD) in patients with Crohn's disease (CD), and to establish a possible relationship between the studied parameters. Material and methods. We examined 35 patients with different clinical Crohn's disease (CD) activity in the course of treatment. ELISA performed determination of IGF-I in peripheral blood. To assess the state of the bone tissue, we used L2-L4 spine densitometry on X-ray densitometers DPX-NT GE, equipped with the computer analytical program. Results. It was found that the active stage of CD, the levels of IGF-I and bone mineral density (BMD) are reduced. In order to study the possible effect of the peptide growth factor IGF-1 on bone mineral density, we studied the production of this peptide in groups of CD patients with osteopenia and osteoporosis. It turned out that the level of IGF-1 was significantly lower in the group of patients with osteoporosis. Conclusion. The performed regression and correlation analyzes revealed a positive moderate dependence of the BMD index on the IGF-I content in the peripheral blood. Clinical remission of CD within 12 months was accompanied by an increase in IGF-I production and an increase in BMD.

Aim. The increase in the incidence of ulcerative colitis (UC) increases the need for a deeper study of the peculiarities of this pathology, particular, in the Rostov region, such as the clinical and morphological characteristics of UC, the possibility of remission on the background of various therapy regimens, recurrence of the disease and its complications. Material and methods. A prospective study was performed. 70 patients with UC were included. Clinical and laboratory instrumental studies were carried out, and the effectiveness of various drug therapy regimens was analyzed. Results. It has been established that UC in the Rostov region mainly affects people of working age, in 1/5 of patients a relapse of the disease occurs against the background of the absence of antirelapse therapy. When evaluating laboratory data, an increase in CRP, ESR, anemic syndrome and leukocytosis is noted. The effectiveness of aminosalicylates therapy was 78%, prednisolone and azathioprine 78%, infliximab in combination with azathioprine 80%. Conclusion. The study revealed the dissociation of clinical, morphological and histological remission of UC in the Rostov region, as well as the high efficiency of different therapeutic approaches in compliant UC patients.

Functional diseases of the gastrointestinal tract are the most common pathology of the gastrointestinal tract, and the combination of several functional diseases determines the special significance of this problem. The article examines the modern understanding of the combined functional pathology of the digestive tract, emphasizes the commonality of the pathogenetic mechanisms of functional disorders of the gastrointestinal tract, polymorphism of clinical manifestations and the peculiarity of the tactics of managing patients with this pathology, based on the latest national and foreign clinical guidelines.

Non-alcoholic fatty liver disease (NAFLD) is an urgent medical and social problem, representing the most widespread liver disease. Different mechanisms of joint progression of liver fibrosis and atherosclerosis, which determine the development of cardiovascular accidents and adverse liver-related outcomes, have now been identified. Patients with NAFLD with initially significant liver fibrosis or its progression according to the data of dynamic monitoring should be considered as patients with increased cardiovascular risk. The development and optimization of dynamic monitoring protocols by an interdisciplinary team of specialists is of critical importance for this category of patients.

Thromboembolic diseases occupy a leading position in the structure of general mortality of the population, and in patients with malignant neoplasms they significantly increase the risk of adverse events. Current article presents the main models for predicting thromboembolic complications in patients with cancer. As follows from the represented data, in a number of cases of pulmonary embolism patients it is possible to prevent the development of a life-threatening complication at the stage of hypercoagulable syndrome. When assessing the risk of thromboembolic complications in patients with malignant neoplasms, a convenient and highly sensitive scale for assessing the risk of thromboembolic complications is required.

The purpose of the article was to summarize modern data concerning physiological effects of melatonin in general and its influence at the gastrointestinal tract, in particular, on the basis of domestic and foreign scientific articles published over the past 7 years. The role of this hormone in the pathogenesis and prognostication of chronic gastritis and peptic ulcer course is highlighted, the results and perspectives of using medicines on it's base in case of functional and organic pathology of the digestive system are outlined. The authors make a conclusion, that, despite a large number of thematic works, the problem of identifying the causes and methods of correcting abovementioned gastrointestinal diseases has not been finally resolved and requires further studies. In addition, the annually increasing number of complications in patients with gastrointestinal tract pathology and the development of antibiotic resistance associated with anti-Helicobacter therapy pose new challenges for improving approaches for elimination of symptoms and prevention of recurrence of peptic ulcer and chronic gastritis. These approaches, among other things, include the use of melatonin in complex therapy, and require further targeted study.

An increase of uric acid (UA) concentration in the blood serum is an important risk factor of cardiovascular pathology, as well as kidney disease. This article presents the results of the analysis and systematization of literature data on drugs of various classes (anti-tuberculosis, cytotoxic drugs, salicylates, etc.), which are associated with the risks of drug-induced hyperuricemia (HU) and gout. Diuretics is a common group of antihypertensive drugs and one of the leading causes of secondary hyperuricemia. The incidence of HU and gout varies between different classes of diuretics and is more commonly associated with loop diuretics than thiazide or thiazide-like diuretics. Among all diuretics, indapamide is associate with fewer cases of serum UA increase in comparison with other diuretics. Among all indapamide formulations available on the market, outstands Indap 2,5 mg tablet, which can be divided into 4 parts and thus provide the possibility to individually adjust the dose and improve the safety of treatment