HERALD of North-Western State Medical University named after I.I. Mechnikov

The global incidence of non-alcoholic fatty liver disease is increasing worldwide, necessating targeted research at both the population and individual levels. Another global health concern is the rising number of patients with sarcopenia. The association between these two diseases, leading to disability, poor prognosis, and increased mortality, is driven by complex interplay mechanisms involving the intestinal microbiota and the formation of the gut–liver and gut–muscle pathogenetic axes. This scientific review aims to identify the causal relationship between intestinal microbiota dysbiosis and the development of sarcopenic non-alcoholic fatty liver disease. Contemporary studies of the intestinal microbiota in patients with sarcopenic non-alcoholic fatty liver disease, conducted at the level of nucleotide sequences of microbial genomic DNA and mitochondrial RNA, have revealed intestinal microbiota dysbiosis as well as increased permeability of the mucosal-epithelial barrier, accompanied by microbial translocation, activation of low-grade inflammatory responses, triggering of pro-inflammatory cytokine production, and the development of metabolic and structural changes in the liver and muscles. This provides the fundamental basis for the formation of bidirectional pathogenetic connections between the intestinal microbiota, liver, and muscles along the gut–liver–muscle axis. Further study of the role of the intestinal microbiota in the development and progression of non-alcoholic fatty liver disease in association with sarcopenia will help to develop a strategy for pathogenetically-based treatment and prevention of these comorbid conditions.

BACKGROUND: Modern component-resolved molecular allergy diagnostics makes it possible to detect true mycogenic sensitization and confirm the development of allergic bronchopulmonary aspergillosis in patients with asthma. Further analysis of the role of fungal allergenic components in the comprehensive diagnosis of mycogenic allergy and allergic bronchopulmonary aspergillosis is needed to predict the effectiveness of allergen-specific and antifungal therapy.

AIM: To conduct a comparative analysis of the levels of specific immunoglobulin E to Aspergillus fumigatus and the recombinant allergen Asp f1 in patients with allergic bronchopulmonary aspergillosis and in asthma patients with and without mycogenic sensitization.

METHODS: The study included patients with allergic bronchopulmonary aspergillosis and asthma patients with and without fungal sensitization. Medical history data, peripheral blood eosinophil counts, pulmonary function test parameters, and Asthma Control Test results were assessed. Total and Aspergillus fumigatus-specific immunoglobulin E levels were determined in blood serum by enzyme-linked immunosorbent assay (Alkor Bio, Russia). Levels of specific immunoglobulin E to the recombinant allergen Asp f1 were determined using the ImmunoCAP method (Phadia, Sweden).

RESULTS: In the allergic bronchopulmonary aspergillosis group (n = 19), significantly lower Asthma Control Test scores, as well as forced expiratory volume in one second, vital capacity, and their ratio, were observed, but significantly higher levels of immunoglobulin E (total and specific) compared to the asthma groups with (n = 11) and without (n = 26) fungal sensitization. Specific immunoglobulin E levels to recombinant Asp f1 >0.35 kUA/L were detected in 94.7%, 36.4%, and 15.4% of patients, respectively (p < 0.001). The median values of this parameter were 32.7 [0.01; 100.0], 0.01 [0.01; 27.3], and 0.01 [0.01; 7.0] kUA/L, respectively (p < 0.001). A significant positive correlation was found between the levels of specific immunoglobulin E to Aspergillus fumigatus and the recombinant allergen Asp f1 and total immunoglobulin E levels in patients with allergic bronchopulmonary aspergillosis.

CONCLUSION: Elevated levels of specific immunoglobulin E to the recombinant allergen Asp f1 indicate true sensitization to Aspergillus fumigatus in patients with asthma and may serve as an additional diagnostic criterion for allergic bronchopulmonary aspergillosis.

BACKGROUND: The most common complication following endoscopic procedures for the treatment of choledocholithiasis is acute post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. It precipitates and accounts for approximately 39% of lethal outcomes after endoscopic retrograde cholangiopancreatography and papillosphincterotomy. From an economic perspective, this translates into prolonged patient stays in the intensive care unit and, in some cases, the necessity for surgical intervention, substantially increasing treatment costs. Currently, the challenge of preventing acute post-ERCP pancreatitis remains incompletely resolved.

AIM: To assess the quality of endoscopic treatment in patients with choledocholithiasis.

METHODS: A retrospective-prospective study was conducted on the treatment outcomes of patients hospitalized in the surgical departments of the Saint Venerable Martyr Elizabeth City Hospital and City Multidisciplinary Hospital No. 2, with a diagnosis of “choledocholithiasis” from 2020 to 2024. A method for assessing the risk of post-ERCP pancreatitis development in patients with choledocholithiasis was developed. Specific risk factors for post-procedural pancreatitis were identified and described. Their influence was analyzed using the Chaddock correlation scale. Based on a logistic regression model and the obtained coefficients, a point-based prognostic scale was created for preventing pancreatitis after endoscopic interventions in this patient category. Patient management strategies for the early postoperative period were developed and implemented.

RESULTS: Treatment outcomes for 216 patients were included. In the retrospective group, 146 patients underwent preoperative examination and surgical intervention according to standard algorithms. The risk of pancreatitis was not calculated; the incidence of the disease was 20.55%, of which severe cases accounted for 2.05%, and mortality was 1.375%. In the main group, 70 patients underwent preoperative examination and transpapillary intervention in accordance with risk stratification for pancreatitis development based on the developed point-based prognostic scale. The incidence of pancreatitis was 11.1%, all cases were mild in severity, with no lethal outcomes.

CONCLUSION: The use of the presented point-based prognostic scale enables the stratification of patients according to the likelihood of developing acute post-ERCP pancreatitis and facilitates differentiated perioperative management aimed at pancreatitis prevention.

BACKGROUND: Predicting the no-reflow phenomenon is an important unresolved problem. Despite certain advances in identifying predictors of this complication of myocardial revascularization, the role of coronary artery structure remains unexplored.

AIM: To determine the range of coronary artery structure variants based on coronary angiography analysis and to assess the influence of the anatomical structure of the coronary bed on the probability of developing the no-reflow phenomenon in patients with ST-segment elevation myocardial infarction.

METHODS: In a single-center case-control study, coronary angiograms were examined and cluster analysis using the K-means method was performed. The influence of coronary artery structure variant on the probability of developing the no-reflow phenomenon was assessed in patients with a primary diagnosis of ST-segment elevation myocardial infarction who underwent stenting of the infarct-related artery.

RESULTS: Based on the analysis of 80 coronary angiograms, the boundaries of the main type and loose type variants of the structure of the main arteries of the heart were identified. The probability of developing the no-reflow phenomenon depending on the coronary artery structure variant was assessed in a group of 143 patients. The main type of infarct-related coronary artery structure statistically significantly increased the probability of developing the no-reflow phenomenon (odds ratio 3.57; 95% confidence interval 1.14–9.03), while the loose type decreased it (odds ratio 0.28; 95% confidence interval 0.11–0.70).

CONCLUSION: The structure variant of the infarct-related coronary artery is a risk factor for the development of the no-reflow phenomenon.

BACKGROUND: In sepsis of any etiology, multiple organ dysfunction develops against the background of an infectious focus. Intestinal failure syndrome, as a link in the pathogenesis, leads to impairment of the motor and barrier functions of the intestine, growth of pathogenic flora, and translocation of toxins into the systemic circulation, exacerbating tissue energy deficiency. Intestinal detoxification using a domestic saline enteral solution (SES) with enteroprotective properties allows for the removal of toxic substances through the enterohematic and enterohepatic circulatory pathways. Further study of the effectiveness of this technique is required.

AIM: To evaluate the role of the intestinal lavage technique (using a saline enteral solution) in the comprehensive treatment of wound sepsis in the intensive care unit setting.

METHODS: A randomized controlled trial was conducted in male patients with wound sepsis. Patients were divided into a main group, which received intestinal lavage with a saline enteral solution at a volume of 2–4 L/day on days 1 and 3 of hospitalization, and a control group receiving standard therapy. Clinical and laboratory status, as well as the dynamics of integral parameters, were assessed on days 1, 3, 5, and 10 of treatment.

RESULTS: The use of intestinal lavage with a saline enteral solution contributed to a more rapid decrease in body temperature, heart rate, and respiratory rate, as well as improvement in hemodynamics and oxygen status. In the main group (n = 23), a more pronounced regression of signs of intestinal insufficiency and accelerated normalization of laboratory inflammatory markers were observed compared to the control group (n = 27). Patients receiving the saline enteral solution were transferred from the intensive care unit earlier: by day 5 — 50% vs. 22% in the control group, by day 10 — 79% vs. 55%.

CONCLUSION: Analysis of the experience of using a saline enteral solution in the comprehensive treatment of wound sepsis as an additional detoxification method showed a positive accelerated dynamics of resolution of systemic inflammation with the use of intestinal lavage and, as a result, earlier transfer of patients from the intensive care unit.

Oral mucositis is one of the most common complications of systemic drug therapy for oncological diseases. With significant severity of its clinical symptoms, dose reduction of medications, changes to their administration schedule, modification of the therapeutic agents used, or complete discontinuation of therapy may be required, which can lead to recurrence of the underlying disease. Treatment of oral mucositis is a complex and not always feasible task.

We present a clinical case demonstrating the difficulties of diagnosis and treatment of oral mucositis in a critically ill patient with an oncological disease complicated by pulmonary embolism and sepsis. Oral mucositis developed after an incomplete course of external beam radiation therapy and chemotherapy with temozolomide. The National Cancer Institute Common Toxicity Criteria score at the time of admission to the intensive care unit was 4 points. Ulceration is a common sign of a wide range of oral diseases involving multiple etiological factors that require careful clinical and histopathological diagnosis. The differential diagnosis was carried out with aphthous stomatitis, herpetic gingivostomatitis, oral erythema multiforme, and vesiculobullous lesions of the oral cavity. The severity of clinical manifestations of oral mucositis and periodontitis correlated with the severity of the patient’s critical condition. Nutritional status and the need for nutritional support were determined using the Nutritional Risk Screening-2002 and Modified Nutrition Risk in Critically Ill scores.

Mixed nutrition with correction according to protein and energy requirements was used. The presence of oropharyngeal dysphagia necessitated the use of food thickeners, followed by a transition to sip feeding. The maximum possible limitation of mechanical damage and an individually selected hygiene regimen (use of toothpaste with a light gel base and plant components) contributed to the earliest possible recovery of the patient’s oral mucosa. The frequency of oral care was determined daily using the Intensive Care Oral Care Frequency Assessment Scale. Following stabilization of the condition, positive dynamics of the oral mucosa were observed, manifested as a reduction in the severity of xerostomia syndrome by 52% according to The Challacombe Scale of Clinical Oral Dryness. A decrease in the Silness–Loe plaque index from 2 to 0.7 points and in the Muhlemann–Cowell gingival bleeding index from 2.2 to 1 point was recorded.

Effective intensive care of oncological disease complications, personalized nutritional support, and an individually selected oral hygiene regimen ensured a favorable outcome of oral mucositis with the possibility of resuming chemotherapy treatment.