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

Cardiovascular diseases pose the main threat to the population health of the Russian Federation and rank the first among the causes of death. Coronary heart disease has the highest standardized mortality rates among the population of the Russian Federation. Comprehensive diagnosis of coronary artery disease includes assessment of coronary atherosclerosis using both non-invasive methods, such as multispiral computed tomography of the coronary arteries, and invasive ones, including coronary angiography, and sometimes intravascular imaging. First two methods are the two most important diagnostic methods for coronary heart disease.

The widespread use of medical technologies based on artificial intelligence in recent years has led to the emergence of new diagnostic and therapeutic opportunities. Artificial intelligence has bridged the gap between massive datasets and useful information by processing and analyzing important data at an unprecedented rate.

The review identifies five potential cases with machine learning having significant prospects in the field of coronary angiography: improving quality and effectiveness, determining plaque characteristics, assessing hemodynamics, predicting disease outcomes and diagnosing non-atherosclerotic lesions of the coronary arteries. While machine learning has transformative potential in the field of coronary angiogram analysis, careful consideration of limitations, including data exchange protocols and interpretability of models is essential to fully exploit its potential and ensure optimal diagnosis and treatment of patients.

In recent decades, Russia, as well as around the world, has recorded a steady increase in the incidence of inflammatory bowel diseases, which include ulcerative colitis and Crohn’s disease. The incidence of inflammatory bowel diseases in Russia accounts for 4.1 per 100 thousand of the population for ulcerative colitis and 0.8 per 100 thousand – for Crohn’s disease. The prevalence of inflammatory bowel diseases in Russia is 19.3–29.8 cases per 100 thousand of the population for ulcerative colitis and 3.0–4.5 per 100 thousand – for Crohn’s disease.

In recent years, selenium has attracted the attention of researchers due to its anti-inflammatory and antioxidant properties as well as its ability to influence the intestinal flora. There is evidence that inflammatory bowel diseases has deficiency of trace elements, which is more often detected during active period of the disease than during remission.

The purpose of the review is to summarize and analyze current literature data on the relationship between selenium and inflammatory bowel diseases, with special emphasis on the mechanism and function of selenium in intestinal inflammation as well as to discuss the possible therapeutic use of selenium in inflammatory bowel diseases. The authors conducted a search for publications in the electronic databases PubMed and eLibrary. After the selection procedure, 87 studies were included in the review.

Due to its anti-inflammatory and antioxidant properties, the concentration of selenium can be crucial in the occurrence and development of inflammatory bowel diseases. Dietary recommendations with the inclusion of selenium gradually improve the quality of life of patients with inflammatory bowel diseases. The development and use of selenium drugs have also provided new therapy strategies. In the future, a large number of experimental and clinical studies are still needed to confirm the relationship between selenium and inflammatory bowel diseases, which, in turn, will mark a new turn in the prevention and treatment of these severe chronic diseases.

BACKGROUND: Human antimicrobial peptides play a significant role in innate immunity. In the oral cavity salivary glands and mucosal epithelium produce human antimicrobial peptides, including defensins and cathelicidin LL-37. Cathelicidin is the most significant peptide protecting against different types of infections, controls the activity of commensal bacteria and prevents colonization and growth of pathogenic bacteria.

AIM: To determine the concentration of cathelicidin LL-37 in the oral fluid of children 2–5 years old and the oral hygiene index depending on some of the parameters and intensity of the carious process in the oral cavity.

MATERIALS AND METHODS: The study was conducted in a group of children aged 2-5 years old; the concentration of catelicidine in the oral fluid was determined by enzyme immunoassay. Moreover, the concentration of Streptococcus mutans in saliva, the presence of Candida albicans in dental plaque, oral hygiene index and the concentration of 25-hydroxycalciferol in venous blood were assessed in these children.

RESULTS: The stydy revealed the dependence of the concentration of cathelicidin in the oral fluid on the intensity of the carious process in children as well as on the concentration of Streptococcus mutans in saliva, the presence of Candida albicans in plaque and poor oral hygiene.

CONCLUSIONS: It was found that in children with high intensity of caries, the concentration of antimicrobial peptide LL-37 is twice lower than in children with low and medium intensity of early childhood caries.

BACKGROUND: The problem of autoimmune liver diseases, which include autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis and their overlap syndromes is an urgent problem of modern medicine. This is associated with an increase in the incidence and prevalence of these nosologies in different regions of the world. Absence of an established etiological factor, prolonged asymptomatic or low-symptomatic course, lack of pathognomonic clinical picture, imperfect diagnostic criteria, insufficient awareness of physicians lead to late diagnosis of autoimmune liver diseases and, accordingly, untimely initiation of treatment, which often reduces its effectiveness, affecting the further prognosis and survival rate for this group of patients. Patients with autoimmune liver diseases require long-term, often lifelong therapy and dispensary observation. Epidemiological registries along with autoimmune liver diseases registries, including various nosologies of autoimmune liver diseases, form an important database on the incidence, clinical features, development and course of the disease, variants of therapy and response to therapy, presence of extrahepatic manifestations as well as allow analysis of all data in dynamics.

AIM: To analize data on various nosologies of autoimmune liver diseases, demographics, clinical symptoms, timing of the first symptoms, timing of diagnosis, and the nature of extrahepatic manifestations.

MATERIALS AND METHODS: This article presents data from the autoimmune liver diseases Register of the North-West Hepatology Centre (North-West Autoimmune Liver Diseases Register) of the North-Western State Medical University named after I.I. Mechnikov.

RESULTS: The study obtained data on the nosological structure, demographic characteristics, timing of diagnosis verification, clinical symptoms and extrahepatic manifestations of autoimmune liver diseases.

CONCLUSIONS: Establishing registers of autoimmune liver diseases, providing information about patients with these diseases, will help to assess the effectiveness of examination and treatment methods, factors affecting the course and prognosis of the disease. Analysis of the data obtained will help to develop screening programs, diagnostic algorithms and differential diagnostics of autoimmune liver diseases, which, in turn, will facilitate the diagnostic process, shorten the time of diagnosis, make it possible to start therapy earlier and, consequently, improve the prognosis and survival rate for this group of patients.

BACKGROUND: The article is devoted to the current problem of intrahepatic cholestasis of pregnancy. This disease complicates the course of pregnancy, worsens the quality of life of patients and is a predictor of obstetric and perinatal complications.

AIM: To analyze clinical features, epidemiology, treatment, and diagnosis of patients with verified intrahepatic cholestasis of pregnancy, to study the relationship between the level of bile acids and the severity of skin itching and the development of complications in newborns.

MATERIALS AND METHODS: Using a retrospective analysis technique, medical histories of patients with intrahepatic cholestasis of pregnancy were studied.

RESULTS: Verified intrahepatic cholestasis of pregnancy was found to be associated with the age over 30 years old, high baseline body mass index (more 25 kg/m²), and with consecutive pregnancy. Most patients (64%) were diagnosed with intrahepatic cholestasis after 36 weeks of pregnancy. Skin itching is the main clinical symptom of intrahepatic cholestasis of pregnancy, which in most cases (46.7%) was pronounced. Meanwhile, the intensity of itching, depended on the level of bile acids (p = 0.00000000001). There is a relationship between the degree of increased levels of bile acids and the appearance of various respiratory disorders in newborns (p = 0.003).

CONCLUSIONS: The topic under consideration will be of interest to specialists in the field of obstetrics and gynecology, gastroenterology, hepatology, and therapy. The issue of diagnosis and treatment of intrahepatic cholestasis of pregnancy requires further study.

BACKGROUND: Inflammation of the synovial membrane is a common manifestation in osteoarthritis which plays a role in complex pathophysiology of osteoarthritis. Synovitis leads to complications during knee replacement.

AIM: To give clinical and morphological characteristics of the knee joint condition by histological assessment of the synovial membrane.

MATERIALS AND METHODS: In the clinic of traumatology and orthopedics of North-Western State Medical University named after I.I. Mechnikov in 2022, 187 total knee arthroplasty operations were performed in patients with osteoarthritis. For morphological study of the synovial membrane of the knee joint biopsy specimens were taken from 30 patients (19 women and 11 men) by randomized sampling method. The age of patients: from 40 to 76 years, the average age was 59,3 ± 6,7 years. Immunohistochemical reactions were performed to characterize the cellular composition of the inflammatory infiltrate; antibodies to CD68, CD3, CD20, CD138, Ki-67 were used. Morphometry was performed at ×400 magnification.

RESULTS: Only 48 (25.7%) patients had at least one course of inpatient conservative or minimally invasive surgical treatment for osteoarthritis of the knee joint before total knee arthroplasty. 18 (9.6%) patients had intraoperative and postoperative complications. Among 30 morphological studies conducted, 3 (10%) patients had verified stage I osteoarthritis of the knee joint, 8 (26.7%) were diagnosed with stage II osteoarthritis, and 19 (63.3%) — stage III osteoarthritis. Significant correlation was obtained between cells stained with antibodies to CD3 and CD20 (r = 0.69; p < 0.05), CD68 and CD138 (r = 0.66; p < 0.05). Cluster analysis identified three groups of patients with severe (10%), moderate (30%) and weak/absent infiltration (60%).

CONCLUSIONS: To correct the treatment strategy for patients with osteoarthritis of the knee joint, it is advisable to strengthen the role of arthroscopic methods in the diagnostic and treatment processes.

COVID-19 is similar to immunoinflammatory rheumatic diseases in clinical manifestations, immune responses and pathogenetic mechanisms. Specific autoantibodies as markers of autoimmune diseases can be detected in patients with coronavirus infection. Most often, after COVID-19, antinuclear antibodies, antibodies to phospholipids, to cardiolipin, to β2-glycoprotein, to cytoplasmic antigens SS-A and SS/B, and cyclic citrulline-containing peptide are detected. In moderate and severe cases of COVID-19 infection with pulmonary-renal syndrome, cytokine storm, antineutrophil cytoplasmic antibodies, antibodies to myeloperoxidase and to proteinase 3 have become more frequent, which can trigger neutrophil NETosis with the formation of extracellular neutrophil traps — networks and induce the development of autoimmune processes and the appearance of de novo immunoinflammatory rheumatic diseases: arthritis , systemic lupus erythematosus, vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA vasculitis). Our study presents 4 clinical cases of patients with ANCA vasculitis with a history of recent coronavirus infection, chronologically verified. The average time after COVID-19 and the onset of ANCA vasculitis was about 3 months; damage to the upper respiratory tract, lower respiratory tract, skin and renal syndromes were observed. The severity of ANCA vasculitis did not depend on the severity of coronavirus infection: a mild course of COVID-19 infection did not exclude a severe course of ANCA vasculitis. It is recommended that all patients during and after coronavirus infection with post-COVID syndrome in the presence of damage to the ENT organs, kidneys, and skin are screened the presence of antineutrophil cytoplasmic antibodies to exclude the onset of ANCA vasculitis.