Vol 14, No 2 (2022)

The growth of the scientific medical community publication activity has led to the emergence of large volumes of disparate, often contradictory information of varying degrees of methodological quality. In such circumstances, a single tool for processing the results of numerous clinical trials was only a matter of time, reflecting the needs of practitioners. Such a tool within the framework of the principles of evidence-based medicine was the conduct of systematic reviews, in some cases supplemented by meta-analyses. The Cochrane is now the leading scientific organization that sets the tone for all research of this kind, providing most of the research of this design every year. Without taking into account the possible negative consequences of such a monopoly, it should be noted that this organization offers a detailed algorithm for writing systematic reviews, which is in the public domain along with the necessary software. This highly transparent methodology makes writing systematic reviews a task within the reach of any professional, regardless of supervision by the Cochrane, whose guiding resource is limited. This work is based on the methodological recommendations of the Cochrane and focuses on the main stages of writing systematic reviews.

BACKGROUND: Arthroscopy is one of the most popular techniques in traumatology and orthopedic practice. The development of the criteria for selection of patients and indications for knee arthroscopy should be carried out for the improvement of arthroscopic technology. It is important to develop safe and informative surgical access to intra-articular structures, optimize stages and techniques, minimize the complications of arthroscopic surgery.

AIM: The publications describing results of knee arthroscopy in patients with knee osteoarthritis have been analyzed in the study.

MATERIALS AND METHODS: A systematic literature review has been conducted by searching in the Pub-Med/MEDLINE database and eLibrary. The search depth was 20 years; a keyword searching has been performed (including the keywords “complications”, “indications/contraindications for arthroscopy”). Possible relevant peri-, intra- and postoperative complications of knee arthroscopy are discussed.

RESULTS: Knee joint arthroscopy is the treatment of choice for trauma, injury and orthopedic disease. However, arthroscopy of the knee joint does not always bring a positive effect. The number of negative consequences of this surgical intervention, according to the statistics, range from 0.1 to 2.6% of all cases of knee joint arthroscopy. Complications can be local and systemic and develop both in the early postoperative and in the long-term period after the operation. The review is devoted to the analysis of the data concerning the frequency and structure of knee arthroscopy complications in patients with osteoarthritis of knee joints.

CONCLUSIONS: Intra- and postoperative complications of arthroscopic surgery of the knee joint include nerve and vascular lesions, port disposition, thrombosis, pulmonary embolism, instrument breakage, and compartment syndrome associated with a defect in the joint capsule and leakage of irrigation fluid. In the postoperative period, complications such as hemarthrosis, thrombosis, pulmonary embolism, infection and synovial fistulas are possible. Complications of the late postoperative period of arthroscopic interventions are arthrofibrosis, Ahlback’s disease or aseptic osteonecrosis of the femur or tibia, as well as complex regional pain syndrome.

BACKGROUND: Inflammatory cascade contributes to the development of chronic heart failure. In this way, Interleukin-6 measurement in serum is relevant for understanding a course and prognosis in patients with chronic heart failure. Interleukin-6 expression correlates with IL-6 gene rs1800795 polymorphism.

AIM: This study analyzes the research articles about Interleukin-6 effects and IL-6 gene rs1800795 polymorphism in the patients with cardiovascular diseases with ischemic etiology.

MATERIALS AND METHODS: Systematic review and synthesis of findings of independent studies addressing the association between Interleukin-6 measurement and IL-6 gene rs1800795 polymorphism in the patients with coronary artery disease and chronic heart failure, including prognosis assessment.

RESULTS: The articles that were focused on the clinical features and outcomes in the patients with coronary artery disease and chronic heart failure depending on Interleukin-6 level have been analyzed. IL-6 gene rs1800795 polymorphism and its clinical significance have been introduced from the perspective of Interleukin-6 expression, C-reactive protein and lipids level in the blood. The meta-analysis data indicate the correlation between the rs1800795 and risk of coronary artery disease in comparison with homozygotes, as well as additive, recessive and dominant models. This review demonstrates relationship of polymorphism determination to left ventricular functioning, risks of chronic heart failure progression and future cardiovascular diseases.

CONCLUSIONS: The present study demonstrates that IL-6 gene rs1800795 polymorphism can provide comprehensive insights for prognosis assessment in patients with chronic heart failure.

BACKGROUND: Gestational diabetes mellitus is a significant medical and social problem in most countries. Despite the relatively high level of development of modern medicine, following the growth of obesity and type 2 diabetes, the prevalence of gestational diabetes mellitus is also increasing worldwide.

AIM: To identify the frequency and structure of carbohydrate metabolism disorders and to compare the level of blood pressure in a random sample of pregnant women registered in the Perinatal center.

MATHERIALS AND METHODS: The analysis of the data of examination of carbohydrate metabolism of pregnant women who are registered in the Perinatal Center (Leningrad region, Gatchina), has been carried out. The analysis of medical documentation, survey, endocrinological and gynecological examination, calculation of the body mass index and the study of carbohydrate metabolism have been carried out.

RESULTS: There is an increase in the number of pregnant women with impaired carbohydrate metabolism over the years of observation. Gestational diabetes on diet therapy was 64.4% in 2019, 31.0% — in 2020, 65.1% — in 2021, on insulin therapy — 32.2, 62.3, 28.9% respectively. There was an increase in the number of women with type 1 and type 2 diabetes diagnosed before pregnancy and newly diagnosed diabetes during pregnancy. Body mass index and blood pressure levels are higher and glycated hemoglobin levels are lower in diet-treated pregnant women with gestational diabetes compared with insulin therapy. An increase in glycated hemoglobin was found annually in a group of women with gestational diabetes mellitus on insulin therapy.

CONCLUSIONS: The high prevalence of carbohydrate metabolism disorders and the associated increase in blood pressure in pregnant women in Saint Petersburg and the Leningrad Region justifies a targeted search for carbohydrate metabolism disorders in pregnant women.

BACKGROUND: Actual mindset, concerning the pathogenesis of type 2 diabetes mellitus and its complications, is described in the glucocentric, lipocentric and lipokine theories. At the same time, it is known, that acute cerebrovascular disorder in type 2 diabetes mellitus can also develop with normoglycemia. The mechanism of association between obesity and type 2 diabetes mellitus in metabolic syndrome has not yet been studied, and 40% of diabetic patients are not obese. In the physiological state hyperglycemia is prevented by pancreatic regulatory oligopeptides rather than insulin, and protein glycation occurs before the development of diabetes symptoms. That facts indicate the need to continue investigation of the pathogenesis in general and diabetic encephalopathy in particular from the standpoint of metabology in order to substantiate the peptidergic theory of the diabetes mellitus and dyscirculatory encephalopathy pathogenesis.

AIM: To consider little-known clinical, morphological and metabolic manifestations of diabetic encephalopathy from the standpoint of improving the disease diagnosis.

MATHERIALS AND METHODS: Among 162 elderly and senile patients in the pre-stroke and stroke stages of diabetic encephalopathy, modern methods of radiological, laboratory, histological, psychometric and clinical analysis have been used: the relationship between low total cholesterol and disease progression has been determined according to Schulte and MMSE psychometric tests with the same hyperglycemia in different age groups sick; cases of amyloid angioencephalopathy on magnetic resonance imaging in the ultrasensitive weighted imaging mode and amyloidosis have been identified.

Staining post-mortem ultrathin tissue biopsy sections with Congo red allowed to find amyloid deposition in 12% of autopsy cases in the absence of diagnosing amyloidosis during life; preparations, in which Congo red staining was positive for the presence of amyloid, were taken for inspection in polarizing light and typing of amyloid. Staining of histological preparations with hematoxylin-eosin and Van Gieson revealed a morphological characteristic of diabetic encephalopathy different from that of atherogenic and hypertensive dyscirculatory encephalopathy; using immunological studies, a statistically significant increased content of induced interleukin-1β production, a trigger for the serum amyloid analogue in the liver synthesis, was determined, and an experimental method for beta-amyloid peptide adhesion by monocytes and the density of amyloid expression on the surface of monocytes in patients with diabetic encephalopathy at senile age at 2–3 times higher than the density of the peptide in the elderly and in the patients with dyscirculatory encephalopathy of the same old age.

RESULTS: It has been established that a fairly frequent and early manifestation of metabolic disorders in diabetic encephalopathy is a violation of protein metabolism with its final conformation into toxic amyloid tissue components. These observations indicate the multifactorial nature of diabetic encephalopathy. Literature data on the parametabolism of the serotonin mediator and tryptophan in the pathogenesis of diabetic encephalopathy are presented.

CONCLUSIONS: Modern immunological, morphological, and histochemical capabilities make it possible to diagnose the conformation of the protein matrix and develop a protein-centric hypothesis of diabetic encephalopathy.