Vol 14, No 3 (2022)

There is a well established theory that an essential amino acid of threonine is incapable of transamination. According to this theory, in a diet of patients who suffer from nephropathy, including diabetic threonine, is not replaced by its ketoanalogue. However, transamination of threonine, in the human organism in particular, has been discovered by a number of researchers. This suggests that there is a possibility of replacing threonine by its nitrogen-free analogues in nutrition of patients with nephropathy. At the same time nitrogen-free analogues of all amino acids can be subject to oxidative decomposition subsequently not only up to the finishing products, but they can also form glucose or ketone bodies, or both. Depending on this, amino acids are divided into glucogenic only, ketogenic only or both at the same time.

With reference to diabetes this becomes especially important as introduction of glucogenic amino acids and their nitrogen-free analogues has a positive effect, whereas that of ketogenic amino acids and their nitrogen-free analogues is inadmissible. This is caused by the fact that before being transformed into glucose, glucogenic amino acids are transformed into one or another component of Krebs cycle or into the pyruvic acid which is in balance with the components which stimulates oxydation of acetyl coenzyme A and, therefore, ketone bodies.

Ketose with reference to diabetes can be caused by two reasons. While the main source of energy of a healthy person is carbohydrate, in case with diabetes fats perform the function — being oxydized intensively, they form a great number of ketone bodies. The second reason is a decrease in the formation of oxaloacetic acid (Krebs cycle catalyst) from pyruvic acid due to a decrease in the formation of the latter from glucose and an increase in the use of the components of the Krebs cycle for gluconeogenesis.

Ketose causes a sharp shift of pH value to more acidity as a result of accumulation of the acetoacetic acid and the β-hydroxybutyric acid in blood and narcotic actions of the third ketonic body — acetone. The reason for lethal outcome with reference to diabetes is diabetic coma caused by a sharp shift of pH value to more acidity, which disturbs the work of the ferments. Threonine has a strong glucogenic effect in the complete absence of a ketogenic effect on the human body. In this respect, nitrogen-free analogues of threonine do not differ from it.

BACKGROUND: To date, the problem of relapse-free treatment in herniology has not been solved. In recent years, the development and wider application of modern technologies in herniology, including endovideosurgical, has been noted. The principles of preparation for surgical interventions, postoperative management and the choice of surgical treatment have also changed significantly, which has affected the improvement of the quality of surgical care for patients with ventral hernias.

AIM: To determine the clinical effectiveness of various methods of surgical treatment of patients with ventral hernias by conducting a systematic review and identifying differences associated with statistical heterogeneity in the study findings.

MATERIALS AND METHODS: More than 1400 domestic publications devoted to surgical treatment of ventral hernias have been preliminarily studied. Taking into account the inclusion and exclusion criteria, the review included 35 domestic scientific publications dated from 2007 to 2020. 8906 cases of surgical treatment of patients with ventral hernias have been analyzed to assess the results of treatment and the clinical effectiveness of various methods.

RESULTS: The wider introduction of endovideosurgical operations into practice has demonstrated the best result in assessing the risk of relapses and postoperative complications. However, the total share of endovideosurgical operations remains small compared to other types of surgical treatment.

CONCLUSIONS: Standardized approaches to the management of surgical patients and the prevention of possible complications due to the principles of evidence-based medicine can improve the overall effectiveness of the treatment of patients with ventral hernias.

BACKGROUND: Decreasing new coronavirus infection-associated morbidity and mortality among patients with rheumatic diseases is one of the main goals of current rheumatology. Vaccination may be one of the ways to limit the incidence of new coronavirus infection in patients with rheumatic diseases.

AIM: To evaluate the results of vaccination in the patients with rheumatic diseases against the new coronavirus infection according to the data from real clinical practice and a review of the literature.

MATERIALS AND METHODS: 68 out of 556 literary medical sources and data from the St. Petersburg register of patients with rheumatic diseases as of September 1, 2021 (n = 16,263) have been analyzed. The data from the register have been compared with the population data on morbidity and mortality from a new coronavirus infection (data of the Ministry of Health of the Russian Federation).

RESULTS: Despite the matched incidence rates of new coronavirus infection associated mortality and morbidity in rheumatological patients and population (morbidity 26.2 and 34.1% mortality 3.47 and 2.8%, respectively), the patients with rheumatic diseases demonstrate three times lower frequency of vaccination against new coronavirus infection (13.2% of patients versus 31.8% in the population, respectively). Vaccination is prescribed by rheumatologists in 8.2%; 75% of patients are self-vaccinated. Data analysis from 2,134 rheumatological patients vaccinated in 2021 have shown a decrease in the incidence of the new coronavirus infection to 0.25% compared to the incidence of unvaccinated patients (25.6%) in the absence of deaths among the vaccinated. There were no serious adverse reactions to vaccination among the vaccinated rheumatological patients; in 12% of the cases, pyrogenic post-vaccination reactions, arthralgias and myalgias have been noted. A prolonged pyrogenic reaction, myalgia, arthralgia, hypercreatinophosphataemia have been revealed in 11 patients, who recovered within 6 months. Exacerbations of the underlying rheumatic disease after vaccination has been revealed in 12% of the cases, all the exacerbations have been resolved with the use of standard tactics recommended by the Association of Russian Rheumatologists.

The question of the timing and the necessity of revaccination, as well as the long-term efficacy and safety of vaccination, has not yet been resolved. Determining the level of antibodies to coronavirus infection can be a useful option in the formation of an individual vaccination plan for rheumatological patients in the present conditions.

CONCLUSIONS: The register data show the efficacy and safety of vaccination against COVID-19 in rheumatological patients in the short term, including in relation to exacerbation of rheumatic disease, and justify the need to comply with epidemiological safety measures after vaccination.

BACKGROUND: The study of antioxidant protection state is important both for diagnosing the influence of forced hypodynamia on the main pathological process and development of the approaches to minimize these adverse manifestations.

AIM: To study the state of antioxidant protection system in blood plasma and erythrocytes in the patients with tibia and femur fractures depending on the duration of immobilization.

MATERIALS AND METHODS: The study involves biochemical examination of 20 patients with shin and hip fractures aged from 18 to 50 years, without a concomitant pathology, who underwent skeletal traction associated with prolonged restriction of motor activity. Blood sampling was performed on the 7^th, 14^th, 21^st, 28^th, and 35^th days after injury. The main parameters of the antioxidant defense system in the blood plasma and erythrocytes have been studied.

RESULTS: A stagewise shift of the studied parameters depending on the time of immobilization has been established. The maximum decrease in the antioxidant defense action has been noted on the 21^th day, while relative stabilization of the indicators has been noted on the 35^th day of the observation.

CONCLUSIONS: The findings can be recommended to estimate the effect of forced limitation of motor activity on the posttraumatic process. The necessity of including vitamins with antioxidant action in the complex therapy of the patients of the corresponding profile has been proved.

Patients with various forms of coronary artery disease often suffer from other comorbid conditions that affect the quality of life and make it difficult to select the optimal therapy. The most acute problem of comorbidity manifests itself in the need for surgical treatment, especially extensive surgical interventions. The key to successful surgical treatment in this category of patients is the work of a multidisciplinary team of specialists deciding on the operability, stages of surgical interventions, choice of methods revascularization and features of patient management in the postoperative period. The article presents a case of successful surgical treatment of the patient with unstable angina and gastric stump cancer, demonstrating the well-coordinated work of a multidisciplinary team of specialists.