Scientific Bulletin of the Omsk State Medical University

This literature review discusses the problem of the causes of digestive symptoms in COVID-19 patients, examining papers in which SARS-CoV-2 gastrointestinal infection was the underlying cause of symptoms and papers in which the occurrence of such symptoms was associated with exacerbation of pre-existing, including previously undiagnosed GI diseases.

Objective: to identify the most likely underlying cause of digestive symptoms in COVID-19 patients. Materials and Methods. We searched 59 literature sources from eLibrary, PubMed, Scopus, and Google scholar databases. All papers were published in the last 4 years.

Results. The resulting digestive symptoms in coronavirus lesions are caused by direct disruption of the intestinal barrier; also, these symptoms may be a manifestation of exacerbation or debut of chronic digestive diseases on the background of COVID-19, and exacerbate the course of infection; or a result of COVID-19 therapy. A differential diagnosis of COVID-19 with inflammatory bowel diseases, chronic liver diseases, chronic and acute biliary pancreatitis is required in patients with diarrhea, abdominal pain, elevated blood liver and pancreatic enzymes. The correlation of gastroenterological symptoms with the direct COVID-19 lesion can be established by comparing the clinical picture with the detection of RNA virus in stool, histologic specimens, but sometimes there may be no unambiguous answer. Specific changes on computed tomography with angiography of the abdominal cavity organs (peri-intestinal fatty tissue strands against the background of intestinal wall thickening) are described only in the initial stage of COVID-19, at later stages the changes are nonspecific. Data from endoscopic studies in patients with COVID-19 are limited to single clinical cases or case series describing nonspecific findings and suggesting that the virus directly damages GI mucosal surfaces. This calls into question the results of the studies that have been conducted, most of which were retrospective and did not evaluate the baseline presence of gastrointestinal symptoms prior to COVID-19. Due to the peculiarities of the virus interaction with body cells and the diversity of clinical manifestations of the disease, a combined approach in the diagnosis of GI diseases in COVID-19 is necessary.

With the appearance of the term "sarcopenia" and its definition, updated in 2010 and 2018, an active study of this phenomenon began. Sarcopenia is a generalized, progressive decline in skeletal muscle mass, strength, and performance leading to reduced quality of life, increased risk of falls, hospitalization, and mortality. Initially, loss of muscle mass was considered an age-associated condition.  Today, there is growing interest in premature sarcopenia, which is seen in the setting of malignancy, malnutrition, and chronic inflammatory processes, including inflammatory bowel disease (IBD). Data regarding sarcopenia in patients with IBS are limited. However, published studies suggest a relationship between sarcopenia and unfavorable postoperative outcomes, need for surgical treatment, and disease activity. It is worth noting that sarcopenia is a fairly common phenomenon among patients with CKD, and is observed in 20-70% of cases. The nature of nutritional status disorders in patients suffering from CLC is undergoing changes due to the widespread epidemic of obesity. Sarcopenia in such patients may occur under the mask of obesity, remaining undiagnosed for a long time.

The aim of the review was to analyze the current information on the incidence of sarcopenia in patients with IBS, its impact on the course of the disease and outcomes of surgical treatment. The following issues need to be addressed today: development of diagnostic criteria for the evaluation of sarcopenia in patients with ICD; inclusion of sarcopenia in the existing models of predicting surgical risks; conducting multicenter prospective studies confirming the influence of sarcopenia on the course and activity of ICD.

Literature search containing information on relevant studies was conducted in PubMed and Google Scholar by keywords: sarcopenia, inflammatory bowel disease, nutritional status, malnutrition, ulcerative colitis, Crohn's disease.

Severe craniocerebral trauma (SCT) leads to a cascade of cellular reactions due to mitochondrial dysfunction and partly due to microglia activation. Simultaneously, the structure of the blood-brain barrier (BBB) is disrupted. Understanding the molecular mechanisms that control the function and integrity of neurons, microglia, and vascular wall elements in the norm is a prerequisite for finding new therapeutic targets in PMT. My-tochondrial dysfunction as a major factor in the development of secondary brain damage after PMT triggers a cascade of the following events: oxidative stress, apoptosis, autophagy, local disruption of blood supply and GEB, glial dysfunction, cell edema and inflammatory reactions of microglia and astrocytes. It is important to identify the role of more than one specific molecular mechanism to allow paralleling between them and finding common points of application. Caspases play a role in cell apoptosis, which affects the Hippo signaling pathway. The anti-apoptosis pathway RSMT1/ Mst1 is formed, which increases Bax expression but decreases Bcl2 expression, all of which leads to caspase-3 activation and provokes enhanced triggering of apoptosis via the mitochondrial pathway. Conversely, miR-21 increases Bcl2 expression but inhibits Bax and caspase-3 expression. Thus suppressing apoptosis and increasing the time of therapeutically potent drug and the ability to accelerate repair mechanisms of secondary cellular damage after tCMT. P53 and mRNA are upregulated after exposure to PMT. Hippo directly acts through p53 and mRNA to control proliferation and expression of pro-apoptotic genes, which will help control all of the above processes. Microglia, or rather the identification of its morphological variants, is of particular interest. Currently, three variants are distinguished: branched, activated (deramified) and amoeba-like. The bacillary microglia, which some authors consider as a special morphology of activated microglia, stands apart. Accurate identification of microglia populations is key to understanding therapeutic approaches that modify the microglial response to PMT and improve long-term outcome measures. Determining which markers or combinations of markers each microglia variant engages is important. The latter has historically been categorized similarly to macrophages by M1 and M2 activation profiles. But there is increasing evidence that individual morphological variants of microglia express specific markers whose activation is realized in a different time frame from M1 and M2. Edema is considered to be one of the important patho-physiological characteristics after severe traumatic injury and an intractable clinical problem. In this review, we described the effects of non-mRNA representatives, including circular RNAs, and AQP on edema.

One of the most urgent problems in medicine today is the problem of antibiotic resistance. Why this problem? After all, scientists around the world proclaimed victory over microorganisms in the 50-60s of the last century? And since the 70s already began to appear information about resistant strains. Everything turned out to be not so simple. Due to uncontrolled and irrational use of antibiotics, mankind is rapidly approaching the so-called "post-antibiotic era". How to stop this "approach"? It is necessary to clearly follow the principles of rational antibiotic therapy.

Rational antibiotic therapy requires identifying the bacterial nature of the disease, determining the sensitivity of the microorganisms to the antibiotic and starting treatment as soon as possible. To comply with these principles, rapid and accurate methods of identification of microorganisms are necessary, because it is on the basis of these methods that the most effective antimicrobial agent is selected.

There are standard methods of identification, which include the disk-diffusion method and the serial dilution method. The main disadvantage of these methods is the length of time it takes to obtain results.

So what are the alternative methods available? There are many methods of microbial identification, but not all of them are suitable for widespread use due to the high cost, the need for expensive equipment.

Of all the current methods, three methods are emphasized in this review: 16S rRNA gene sequencing, MALDI-TOF MS and EUCAST RAST. Sequencing of the 16S rRNA gene is based on decoding the region of the gene, which in bacteria carries information on resistance mechanisms and structure features. MALDI-TOF MS is a desorption method of "soft" ionization caused by exposure of the matrix with the analyzed substance to pulses of laser radiation. The EUCAST RAST method is an accelerated disk-diffusion method.

This review describes the problem of antibiotic resistance, mechanisms of bacterial resistance, as well as modern and standard methods of bacterial identification and antibiotic sensitivity.

The aim of this review was to compare routine methods of identification of species and qualitative properties of microorganisms, causative agents of nosocomial infections, with modern technologies of microbiological testing as an important step in solving the problem of priority selection of effective antimicrobial agents.

So, the main question of this review is: can modern methods displace standard methods of microorganism identification?

The article considers the peculiarities of knowledge translation in modern professional education, reveals the negative sides of scientificity of educational content. In particular, the separation of the subject and object of research characteristic of scientific consciousness can negatively affect the formation of the subject of professional activity in the process of professional education. After all, the subject of scientific research, in order to remain in scientific positions, should not be partial to the studied object, inextricably link his life with it. At the moment, higher school should not only transfer scientific knowledge to future specialists, but also educate them as professionals, linking their lives with their profession, as well as patriots, ready to defend their country. In this regard, since this year a new subject - "Fundamentals of Russian Statehood" - has been included in the curriculum. At the same time, students' mastering the content of this discipline as a purely scientific one may not lead to the formation of their patriotic position. In this regard, the authors of the article suggest that when teaching such disciplines to emphasize not on the scientificity, but on the symbolism of the content taught. In this connection, the article considers the differences between scientific and symbolic content of education, defines the concept of symbol, establishes the role of symbols in human life and education.

Material and methods. When writing the article we relied on the works of A. F. Losev, in which he unfolds a dialectical understanding of the symbol and its role in people's lives. Following A. F. Losev, we use the dialectical approach to understand human existence and the role of symbols in it. Naturally, the education of people is inextricably linked to their existence, which means that it cannot do without symbols. Relying on the dialectics presented in the works of A. F. Losev, we designate this approach as dialectical-symbolic.

Results. According to the results of our study, in the process of education it is necessary not only to transfer scientific knowledge to students, but also to familiarize them with appropriate symbols. Such familiarization will allow to form them as patriots of their country and as full-fledged subjects of professional activity.