Vol 3, No 1 (2023)
Articles
Prospective solution of the problem of postoperative ileus in urology and traumatology
Abstract
In surgical practice, after operations that directly or indirectly affect the organs of the abdominal cavity, it is possible to develop disturbances in the normal coordinated propulsive motility of the gastrointestinal tract. This condition of dynamic intestinal obstruction is referred to as postoperative gastrointestinal paresis or postoperative ileus (POI). We did not find any information on the frequency of POI in urological practice, however, the frequency of POI in the clinic of colorectal surgery is known to be from 10 to 30% and after gynecological operations 10-15%. The issue of treatment and prevention of POI remains relevant.
In global clinical practice, chewing gum has been used after surgery to reduce postoperative intestinal obstruction since the beginning of the 21st century. 141 references were found for the query “postoperative ileus, chewing gum” in the PubMed database alone, of which 53 references to randomized clinical trials, 48 to reviews and systematic reviews, and 26 to meta-analyses.
The present review considers randomized clinical trials, systematic reviews and meta-analyzes that examined the prevention of POI in urology and traumatology, indicating the effectiveness and safety of the use of chewing gum in the postoperative period for the prevention of postoperative ileus.
2-10
Combination of infectious complications in a patient with immunosuppression (clinical case)
Abstract
Against the background of high incidence of new coronavirus infection there is a widespread increase in the incidence of co-infections, in particular, with HIV infection. Difficulties of differential diagnosis of infectious diseases in such a situation are similar clinical picture, similar radiological changes in the lungs (primarily with pneumocystis pneumonia and viral lesions caused by SARS-CoV-2), reduced availability of medical diagnostic procedures in a pandemic. The presented clinical case demonstrates a rare combination of co-infection - COVID-19, pneumocystis pneumonia and tuberculosis - in a patient with human immunodeficiency virus; the course of these infectious complications is described. A patient with a low level of CD4+ -T - lymphocytes, a high viral load, concomitant renal and hepatic pathology had long-term persistence of SARS-CoV-2 (longcoid). The presence of a "trio" of infectious diseases made timely diagnosis of tuberculosis difficult. During the COVID-19 pandemic, surveillance of individuals living with HIV should include a spectrum of investigations to rule out tuberculosis and opportunistic infections, especially in individuals with low CD4 cell counts, high viral load, lack of antiretroviral therapy, and clinical improvement with standard COVID-19 therapy for timely therapy and reduced mortality in such patients.
11-17
The problem of the untenableness of the uterine scar after cesarean section
Abstract
Over the past decades, the frequency of cesarean section operations in the world has increased by 50%, and in the Russian Federation – by 10 times, and doctors are increasingly witnessing the formation of untenable scars on the uterus. The appearance of a scar on the uterus after cesarean section is inevitable, since smooth muscle tissue has a minimal ability to proliferate and regenerate after the damage. The frequency of occurrence of an untenable scar ranges from 19% to 86%, which is explained by the complexity of diagnosing this condition. The most common clinical manifestations of scar defect are abnormal uterine bleeding, chronic pelvic pain, dysmenorrhea, infertility; as well as an asymptomatic period that is often found. Currently, there is no common terminology and clear criteria and recommendations for assessing an untenable scar on the uterus. The only generally accepted is the Delphi international consensus, approved by European experts in 2019, but it is applicable only to the ultrasound assessment of the scar. The use of sonohysterography with saline solution is considered promising in diagnostics. The treatment is indicated in case of symptoms and a woman's desire to restore lost fertility. The possibilities of medication treatment of scar failure are very limited and insufficiently investigated. Modern research suggests performing a minimally invasive defect resection procedure as a first-choice operation. Currently, there is an active discussion about the preferred method of delivery in women with a scar on the uterus. Recent studies indicate that up to 75% of patients who have undergone cesarean section surgery can successfully undergo vaginal delivery. Successful vaginal delivery is associated with fewer complications than a repeated cesarean birth. Nowadays, the frequency of vaginal delivery in patients with a scar on the uterus in the Russian Federation does not exceed 1,5%. An additional study of the causes regarding formation of an untenable scar on the uterus and the improvements of therapeutic and diagnostic measures are required.
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Modern approaches to pharmacotherapy of alzheimer's disease
Abstract
Currently, about 50 million people suffer from Alzheimer's disease, and this number will only increase over time. There are only four clinically approved drugs to treat this pathology, which include acetylcholinesterase inhibitors (Rivastigmine, Donepezil, and Galantamine) and one N-methyl-D-aspartic acid receptor antagonist (memantine). Although these drugs have a therapeutic effect by improving the cognitive, functional, and behavioral characteristics of patients, they still relieve symptoms of the disease rather than manifest the links of pathogenesis, including β-amyloid precursor protein and hyperphosphorylated tau protein formed during the cleavage of amyloid precursor protein. This group of drugs also has a number of undesirable effects on the gastrointestinal tract, cardiovascular system and nervous activity. In this regard, new drugs are being developed now, directed against β-amyloid and affecting to reduce its production, aggregation, not allowing it to form plaques, the use of immunization method. There is also hyperphosphorylated tau protein, which is either not allowed to form or is immunized against. In addition to these methods, there are no less interesting ways to fight, such as the use of heat shock inducers, to activate the necessary chaperone family, or to reduce neuroinflammation by inhibiting tumor necrosis factors and using nutraceuticals. But, unfortunately, a large number of drugs cannot yet pass all 3 stages of clinical trials while maintaining their original therapeutic properties and without acquiring undesirable effects. That said, many drugs are either the basis for future drugs or are still participating in clinical trials themselves, showing encouraging results.
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COVID-19 and arterial hypertension: points of contact and outcomes of the pathological process
Abstract
Today, the world is at the mercy of a new virus belonging to the coronavirus family called SARS-CoV-2, and the infection it causes is called COVID-19. The virus can be traced back to December 2019, and is known to have originated in Wuhan district of Hubei province in China. This highly contagious virus has spread to 220 countries and territories around the world, and by mid-March 2020, the World Health Organization recognized it as a pandemic. The infection spreads from person to person through close contact, from mostly symptomatic individuals and asymptomatic carriers. Studies have shown that arterial hypertension (AH), along with diabetes mellitus and cardiovascular disease, were the most common comorbidities among patients with coronavirus infection (COVID-19). Arterial hypertension was consistently listed as the most common risk factor in patients with COVID-19. Several studies have suggested a link between the renin-angiotensin-aldosterone system (RAAS) and susceptibility to COVID-19, as well as a link between RAAS inhibitors and increased mortality in these patients. This has raised concerns about the potential association between AH (and its treatment) and susceptibility to COVID-19. There have been several follow-up studies examining the effect of comorbidities on outcome in these patients with conflicting results. Arterial hypertension has been shown to be more common in patients with an adverse outcome (admission to the ICU, use of a ventilator, or death). So far, there are no studies demonstrating an independent prognostic value of arterial hypertension on mortality in patients with COVID-19. There is much speculation about coronavirus infection and its association with various risk factors and underlying diseases. The purpose of this review is to summarize current knowledge about the relationship between AH and COVID-19 and its role in outcome in these patients.
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Pros and cons of hormone replacement therapy
Abstract
This literature review considered the positive effects and possible risks of hormone replacement therapy. To assess the efficacy and safety of hormone therapy, the materials on the topic presented in the biomedical research search engine PubMed, the Russian scientific electronic library CyberLeninck, and the State Registry of Medicines were studied. The results of clinical trials of hormone replacement therapy to treat early symptoms and prevent later postmenopausal women from developing osteoporosis, osteopenia, periodontal disease, and cardiovascular disease are presented. Risks of certain cancers from hormone therapy have been assessed. There is much debate about the safety of hormone therapy for the treatment of menopause and andropause. Proponents of this therapy believe it is necessary to treat early symptoms and prevent women from developing osteoporosis and cardiovascular disease later in postmenopause. A second group believes that taking hormones is associated with an increased risk of certain cancers. There is evidence that hormone replacement therapy can provoke the risk of developing breast cancer, endometrial cancer, and prostate cancer. The purpose of this review was to update hormone replacement therapy as a treatment option for menopause and andropause. According to the results of the studied data, we can conclude that hormone replacement therapy in general has both significant advantages and disadvantages. At this time we can not say that hormone replacement therapy is absolutely safe method of treatment, because there are still new studies in which there may be disagreement among authors about the safety of estrogen or testosterone therapy. This method of treatment is not advisable for every patient, so the doctor should take into account the individual characteristics of the patient and have a good understanding of the possible risks and consequences of hormone replacement therapy. Further research is needed to confirm the safety of hormone replacement therapy and to find new pharmacological options for the hormone therapy approach.
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The role of autophagy in cardiac damage
Abstract
Autophagy is one of the mechanisms ensuring cell homeostasis on the one hand, and on the other hand, it is a way of utilizing damaged cell structures through their autolysis in the autophagosome for reuse in cell metabolism. Autophagy is usually considered as an adaptive process allowing cells to survive under conditions of stress, nutrient deficiency and hypoxia. However, under certain circumstances autophagy can be the cause of cell death. Cell death accompanied by autophagy activation and autophagosome accumulation has been classified as programmed cell death type II. However, compared to detailed information on the adaptive role of autophagy, its involvement in cell death has been poorly understood. Autophagic cell death can be divided into two groups, namely: (1) autophagic cell death with increased autophagy activity; (2) autophagic cell death with decreased autophagy processes. In the first scenario, autophagy is excessively activated, causing uncontrolled autolysis of cellular structures and cell death. A similar scenario is observed in cell death caused by excessive degradation of damaged organelles in lysosomes. Of particular interest is a specific form of autophagy in which damaged mitochondria are excessively eliminated from the cell - mitophagy. Autophagic cell death is characteristic of diabetic cardiomyopathy. The second variant, characterized by reduced autophagy processes, is observed in doxorubicin-induced cardiomyopathy, autophagy during ischemia/reperfusion and autophagic cell death in lysosomal accumulation diseases. In this scenario, the final step of autophagy is usually disrupted, and an imbalance between autophagosome formation and lysosomal activity leads to massive autophagosome accumulation, which subsequently causes cellular dysfunction and death. Dysregulation of autophagy causes a unique form of cell death, called autosis, with certain morphological and biochemical features that differ from other forms of cell death, such as apoptosis and necrosis. In autosis, Na+/K+ ATPase plays a special role, which by physically interacting with Beclin 1 can promote autophagic cell death. The principles of therapeutic intervention aimed at preventing autophagic death of cardiomyocytes depend on the specific mechanisms of autophagy. For example, the use of Na+/K+-ATPase inhibitors, such as cardiac glycosides, provides a cardioprotective effect by inhibiting autophagy, while the use of trehalose and 3,4-dimethoxychalcon, can optimize autophagy processes and reduce the intensity of excessive autophagosome accumulation. Thus, the study of mechanisms of autophagy and search for new approaches in pharmacocorrection and pharmacoprophylaxis of autophagic cell death are actual directions of modern scientific research. The aim of the review is to present the concept of autophagic cell death in some heart diseases.
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Innovative methods for the treatment of pulpitis in permanent teeth with unformed roots in children
Abstract
When treating pulpitis of permanent teeth with unformed roots in children, the dentist primarily relies on the knowledge of the morphological structure of their root systems. Therefore, currently, when choosing the tactics of endodontic management of such children preference is given to classical techniques, in particular - vital amputation. The latter involves necrectomy of the infected crown part of the pulp, while the root part remains intact and is covered with a therapeutic agent. This condition is necessary for the successful completion of apexification, i.e. the closure of the root apex during its development stage. A wide range of drugs that stimulate apexification is available when performing a vital amputation. The most effective of these are preparations based on calcium hydroxide, mineral trioxide aggregate (MTA) and paraformaldehyde. However, clinical experience shows that these preparations are not without significant drawbacks, the main of which is dehydration of root dentin, which contributes to the fragility of the root and therefore increases the risk of root fracture of the tooth. Furthermore, treatment with calcium-based formulations is lengthy and requires a large number of visits. To address these shortcomings, the American Association of Endodontics has proposed an alternative technique, revascularization (regenerative endodontic treatment), based on irritation of periapical tissues by intensive instrumentation of root canals to stimulate bleeding and form a blood clot containing induced stem cells and growth factors that promote apex closure. In this regard, this literature review describes clinical studies of recent years containing a comparative analysis of the most common drugs used in the treatment of pulpitis in teeth with unformed roots by the method of vital amputation, as well as the latest prospective studies containing the results of clinical application of the revascularization technique.
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Alcohol surrogate poisoning: statistics for the country and individual regions
Abstract
Alcohol abuse around the world is a risk factor for death and disability, so the problem of mortality due to excessive consumption of alcoholic beverages is extremely urgent. Alcoholism is widespread among people of different nationalities, and is part of the lifestyle of people of different sex and age. The risk of death regardless of the cause increases with an increase in alcohol addiction. People who abuse alcohol are at high risk for cognitive impairment, tendency to depression and anxiety, and have many co-morbidities. Alcoholic beverages can act as both an initiator of harm to oneself or another person as well as a cause of premature death, such as poisonings of chemical etiology, which include: poisonings from medications, drugs, alcohol and its surrogates. Toxic alcohols are readily available and contained in many household and industrial products, so mass poisonings with surrogate alcohol are registered almost every month in the Russian Federation. The aim of the literature review was to analyze the statistics and identify the connection between the excessive consumption of alcohol and its surrogates and the high mortality rates in the Russian Federation and individual regions. To achieve our goal, we had to solve a number of tasks. To begin with, we collected literature for the period 2012-2022 on this problem from the main biomedical information sources, such as PuBMed and eLIBRARY.RU. Next, we reviewed the mortality statistics of the Russian Federation and, in particular, the Omsk region for the period 2012-2022. Then we evaluated the correlation between the excessive consumption of alcohol-containing products and high mortality. We went deeper into the study of this problem and analyzed the correlation between the mortality rate and alcohol detection during the examination and mortality from other somatic diseases. We evaluated the frequency of acute poisonings of chemical nature, namely fatal poisonings of alcohol etiology. We identified the most frequent chemical that provoked the fatal outcome. We also considered the risk of mortality in relation to gender and age.
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Omega-3 fatty acids: promising plant sources and effects on the human body
Abstract
Omega-3 polyunsaturated fatty acids (PUFAs) are essential for humans and their presence in the diet is essential. Eicosapentaenoic and docosahexanoic acids attract special attention. Omega-3 PUFAs are responsible for the formation of three types of enzymes in the body, the formation of some cell membranes, and also have a number of important pharmacological properties: anti-inflammatory, antioxidant, anticoagulation effect, help to reduce the viscosity of the membrane of cardiomyocytes, etc. Some researchers cite the mechanism of action of Omega-3 PUFAs: inhibition of anti-inflammatory and activation of anti-inflammatory eicosanoids synthesis, reduction of platelet aggregation factor, tumor necrosis factor and interleukin-1 production, normalization of lipid metabolism. Currently, Omega-3 PUFAs are used as a prophylactic in cardiovascular diseases, chronic obstructive pulmonary disease, thrombosis and other pathologies. At the same time, the use of Omega-3 PUFAs may produce side effects such as increased risk of bleeding, headaches, nausea and vomiting, and dyspeptic disorders. The potential use of these compounds in other nosologies is still being studied, and interest in them is not waning. In this regard, sources of Omega-3 PUFAs are being studied and compared. Animal sources are the most common, but plant sources are also being considered as alternatives. Researchers are interested in the differences between plant and animal Omega-3 PUFAs, as well as in the possibilities of using plant sources as a source of polyunsaturated fatty acids. In this regard, new producing plants are being sought. The traditional source of Omega-3 PUFAs is flaxseed oil, which contains the highest amount of α-linolenic acid. However, sources containing eicosapentaenoic, eicosadienoic and docosahexanoic acids are also of interest. Such sources can be plants of the genus astragalus (Astragalus glycyphyllus L.), Astragalus albicaulis DS), nigella (Nigella arvensis L. ), nigella damascena L.), mustard (Brassica juncea (L.) Czerniak)), hemp (Cannabis sativa L.)), moringa (Moringa oleifera Lam.)) due to their complex composition. In addition to fatty acids, the seed oil of these plants also has a large amount of tocopherols, which is important for the further development of medicines containing Omega-3 PUFAs.
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