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The Russian Archives of Internal Medicine

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Vol 10, No 4 (2020)
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LECTURES

247-253 1290
Abstract

Vilém Dušan Lambl, better known in Russia as Dushan Fedorovich Lambl (1824-1895) — Czech and Russian anatomist, histologist, therapist and parasitologist, doctor of medicine, professor, head of the department of normal anatomy and pathological anatomy of the Imperial Kharkov University (from 1860 to 1871), head of the Faculty therapeutic Department of the Imperial University of Warsaw (from 1871 to 1895), Privy Councilor.

Professor Lambl D.F. the main works on parasitology (he was the first to describe in 1859 the simplest microorganism that parasitizes humans and now bears his name), pathological anatomy (his famous lithographs written on stone), normal anatomy, internal medicine, as well as natural science, ethnography, culture and linguistics of Slavs and others. He was a man with the broadest horizons, sharpness of thought, excellent erudition and incredible knowledge in the field of both fundamental and practical medicine. 

REVIEW ARTICLE

254-261 1409
Abstract
Modern concepts about the role of connective tissue growth factor in various physiological and pathological processes are described in the review. Connective tissue growth factor regulates a variety of cellular functions, including proliferation, migration, adhesion, differentiation and synthesis of extracellular matrix proteins in cells of different types. This factor is also involved in more complex biological processes of angiogenesis, chondrogenesis, wound healing, fibrosis and oncogenesis. Increased expression of connective tissue growth factor is observed in different cardiovascular and oncological diseases. Potential role of this growth factor in regulation of cellular senescence and aging processes is also discussed.
262-271 3224
Abstract

Triiodothyronine (T3, 3,5,3’-L-triiodothyronine) is a thyroid hormone (thyroid), the secretion of which is carried out directly both by the gland (to a lesser extent) and outside it (the main amount; as a result of peripheral deiodination of thyroxine (T4)). Getting into the nuclei of cells, T3 interacts with specific nuclear receptors of target tissues, which determines its biological activity. This interaction leads to the activation of transcription of a number of genes.

In the pituitary gland and peripheral tissues, the action of thyroid hormones is modulated by local deiodinases, which convert T4 to more active T3, the molecular effects of which in individual tissues depend on subtypes of T3 receptors and their interaction with other ligands, coactivators and corepressors, as well as on the activation or repression of specific genes.

The reason for the lack of T3 production is primarily a deficiency of iodine in the diet, less often, a defect in the genes encoding the proteins that are involved in T3 biosynthesis. As a result of the low intake of iodide in the body, the so-called adaptive mechanism is activated, which consists in increasing the proportion of synthesized T3, which increases the metabolic efficiency of thyroid homones. With a deficiency in the diet of such a trace element as selenium, the conversion of T4 to T3 is reduced.

Thyroid hormones play a vital role in the regulation of homeostasis and the metabolic rate of cells and tissues of humans and mammals. They are necessary for physical and mental development. Their insufficient production at the stage of formation of the internal organs of the fetus and in childhood can lead to various pathologies, primarily to pathology of the central nervous system, and as a result, growth retardation and mental retardation. In adulthood, hypothyroidism leads to a decrease in metabolism, memory impairment, depressive disorders, impaired fertility. Many discussions and ambiguous conclusions have been obtained regarding combination drugs (sodium levothyroxine + lyothironon) for the treatment of hypothyroidism. This article will examine the metabolic effects of T3, the thyroid hormone with the highest activity. 

272-280 1445
Abstract
Cholesterol atheroembolism syndrome is a systemic pathological process caused by the embolization of small arteries with cholesterol crystals, which can develop spontaneously, and it is the result of intravascular surgery and / or the use of anticoagulants. Embolization cholesterol crystals leads to ischemic and inflammatory organ damage. The clinical picture is variable, various organs can be targets, but skin and kidneys are mainly affected. Specific clinical and laboratory signs aren’t. Tissue biopsy is the gold standard for diagnosis cholesterol atheroembolism syndrome. The treatment is based on the correction of classical cardiovascular risk factors, the use of statins. In terms of benefit and risk failure from anticoagulants and thrombolytics should be considered. Studies on the use of corticosteroids, cytostatic, and colchicine have conflicting results. The use of monoclonal antibodies of IL-1 antagonists is a perspective direction.

ORIGINAL ARTICLES

281-287 1313
Abstract

The aim — predicting the growth of gallstone disease based on the study of the dynamics of the incidence of the liver.

Materials and methods. In clinical conditions, 98 patients (62 women and 36 men, average age 43.4 ± 3.3 years (21-60)) with various chronic liver diseases were examined. Anamnesis, clinical and laboratory data were used to verify the diagnosis. In portions “B” and “C” of bile obtained by multifractional duodenal sounding, the total concentration of bile acids, cholesterol and phospholipids was determined, and lithogenicity indices of bile were calculated: cholate-cholesterol and phospholipid-cholesterol coefficients. The results were analyzed using Microsoft Excel 2010 and PSPP statistical processing programs. The next stage of the work was the analysis of statistical indicators of the general and primary liver morbidity in the Udmurt Republic over the past 10 years (2008-2018). The study applied statistical forecasting methods. Models were built in the Microsoft Excel 2010 program in a polynomial trend.

Results. In 52 (53,1%) examined patients, ultrasound examination of the gallbladder were signs of biliary sludge. Microscopic examination of bile 71 (72,6%) patients had crystals of cholesterol and calcium bilirubinate, which is evidence of stage I gallstone disease. In all patients with biliary sludge, a violation of the biochemical composition of bile was noted — a decrease in the concentration of bile acids and phospholipids, an increase in the concentration of cholesterol, a decrease in cholesterol and phospholipid-cholesterol coefficients. When studying statistical indicators over the past 10 years, a higher general and primary incidence of liver diseases in the Udmurt Republic was noted than in the Russian Federation as a whole. Based on the results of trend modeling, a significant increase in the total and primary liver morbidity is predicted both in the Udmurt Republic and in the Russian Federation.

Conclusion. Summarizing the data obtained, it can be noted that over the past 10 years (from 2008 to 2018) among the adult population of Udmurt Republic, a clear tendency has been revealed for an increase in the general and primary incidence of the liver. As the results of trend forecasting showed, an increase in the incidence of the liver will continue in the coming years. With liver pathology, bile secretory function suffers, as a result of metabolic processes, bile produces supersaturated cholesterol, which is the basis for stone formation in the gall bladder. A study of the dynamics of liver disease allows predicting an increase in cholelithiasis in the coming years. Despite the fact that the asymptomatic course of cholelithiasis is often quite observed, if this disease is not diagnosed and the preventive treatment of stone formation is not carried out in a timely manner, this leads to the development of serious complications. 

288-295 960
Abstract

Purpose of the study: The aim of study was to analyze the characteristics of hormonal-metabolic parameters in men with a metabolically unhealthy obesity phenotype; identify the value of special indicators for diagnosis of insulin resistance.

Materials and methods: The examination included 108 patients with body mass index ≥25 kg/m2, which were hospitalized. According to the current national guidelines for the diagnosis and treatment of obesity, all examined patients were divided into 2 groups: 1 — with metabolically healthy obesity phenotype, 2 — with metabolically unhealthy obesity phenotype. The study presents the results of comparative simultaneous nonrandomized study of two groups with using of different methods of examination (anthropometric indicators, laboratory tests for inspection of the hormonal profile, biochemistry parameters, and calculation of TyG index for diagnosis of insulin resistance).

Results and discussion: The study found that patients of working age with metabolically unhealthy obesity phenotype are characterized by unfavorable anthropometric and hormonal-metabolic parameters and more severe polymorbid pathology (first of all cardiovascular diseases). The results of study revealed the value of special indicators for the diagnosis of insulin resistance (visceral obesity index >1,85; TyG >3,98; fat mass >30,1).

Conclusion: timely detection of insulin resistance indicators has great importance and practical application due to simplicity and accessibility. 

296-304 1479
Abstract

Aim. To determine the value of concomitant non-alcoholic fatty liver disease in patients with arterial hypertension in the progression of rigidity of the main arteries and in increase of risk of cardiovascular complications.

Material and methods. A cross-sectional comparative study was conducted. Group 1 (n=50, 35(70%) women, average age 57,4±6,9 years) included patients with arterial hypertension and non-alcoholic fatty liver disease, group 2 (n=50, 40(80%) women, average age 56,5±7,0 years) included patients with arterial hypertension only. The groups were comparable in the main clinical and demographic indicators (p>0,05). A comparative analysis of pulse wave velocity, central aortic pressure, vascular age and a 10-year risk of developing cardiovascular complications in both groups was performed.

Results. There is a statistically larger number of patients with metabolic index>7,0 (58,0% vs 28,0%, p=0,0019). It was also established that systolic (121,9±10,9 mm Hg vs 115,9±8,9 mm Hg) and diastolic (82,5±9,3 mm Hg vs 77,4±8,9 mm Hg) aortic pressure, as well as the augmentation index (26,5±8,5% vs 18,6±4,2%), were significantly higher in patients with arterial hypertension and non-alcoholic fatty liver disease than in patients with isolated arterial hypertension. In the 1st group, a statistically significant increased pulse wave velocity was found both in muscular (12,0±3,1 m/s vs 10,6±1,8 m/s) and elastic (10,4±2,8 m/s vs 9,1±1,7 m/s) vessels, which indicates an increase in arterial stiffness. In addition, there was an increase in post-occlusal pulse wave velocity in this category of patients (11,0±3,3 m/s vs 9,4±1,9 m/s, p=0,0037). A significant increase in vascular age in relation to the passport age (60,4 [56,0:68,0] years vs 58,0 [53,0:60,0] years) and an increase in the 10-year fatal risk was detected (2,15 [1,42: 4,63] and 1,05 [0,52: 2,82] %, p = 0,0043 ) were also revealed in patients with arterial hypertension and non-alcoholic fatty liver disease compared to patients with isolated arterial hypertension. Significantly more patients with a high (13 (26,0%) vs 5 (10,0%), p = 0,0332) total cardiovascular risk were observed in group 1 than in group 2.

Conclusions. Arterial stiffness was significantly higher in patients with arterial hypertension and non-alcoholic fatty liver disease than in patients with isolated arterial hypertension, which is confirmed by a statistically significant increase in pulse wave velocity and central aortic pressure. Comorbid patients have pronounced endothelial dysfunction, which is confirmed by a significant increase in the post-occlusion rate of the pulse wave. An increase in vascular age in relation to the passport age indicates earlier aging of blood vessels in the 1st group compared with the 2nd group. Patients in the main group have a higher incidence of a high 10-year risk of developing cardiovascular events compared with patients in the control group. 

305-313 906
Abstract

Study Objective is to evaluate prevalence of hepatitis A, B, C, E, and TT virus infection markers in highly qualified sportsmen. Study Design: multicenter open single-site clinical study.

Materials and Methods: 100 blood serum samples of sportsmen (game, complex coordination, technical, etc.) were studied. Biological material (blood serum) was obtained from 54 men and 46 women aged 16 to 45 years during an in-depth medical examination. All sportsmen filled out a questionnaire, including demographic data, description of the sport, information about infection risk factors, information about the presence of acute viral hepatitis and vaccination. Anti-HAV IgG, HBsAg, anti-HBcore, anti-HCV, anti-HEV IgG, anti-HEV IgM were determined in the blood serum by enzyme immunoassay; using polymerase chain reaction — DNA Anelloviridae (TTV, TTMDV, TTMV).

Study Results: Anti-HAV IgG was detected in 57/66 (86,4%) sportsmen, women (91,2%) predominated, among them a third were engaged in synchronized swimming. 7/57 (12,3%) of the examined had indications of vaccination against hepatitis A. The frequency of anti-HEV IgG did not exceed 3% (2/66). anti-HEV IgM were not detected in any case. Also, none of the examined sportsmen in the blood serum was not determined HBsAg. However, anti-HBcore (marker of latent HBV infection) was detected in 13% (13/100) of the samples. The detection rate of anti-HCV was low, combined with the presence of anti-HBcore was 2% (2/100). In addition, DNA TTV, TTMDV and TTMV, respectively, were found in serum samples from 66/100 (86%), 79/100 (79%), 71/100 of sportsmen.

Conclusion: The high frequency of hepatitis virus markers was found (HAV — 74,1%, TTV/TTMDV /TTMV — 71-86%), HBV — 13%, HEV — 3%, HCV — 2%). All patients denied a history of acute viral hepatitis. Vaccination against hepatitis A and B is a modern strategy that prevents infection and the development of acute viral hepatitis. Its mandatory holding should become part of the targeted preparation of sportsmen to achieve the highest sports results. 

ANALYSIS OF CLINICAL CASES

314-321 1272
Abstract
The article concerns one of the common adverse effects during treatment — steroid myopathy. The information about pathogenic specifics of myopathy development in administration of glucocorticoids, the most typical clinical manifestations are described, and results diagnostic methods with estimation of a role of enzyme level evaluation, electromyography, ultrasound study of the muscle tissue, computer and magnetic resonance tomography. There is description of muscle weakness development in 49-year old woman who has been receiving methylprednisolone 88 mg/day due to revealed thrombocytopenia. One week after the treatment was started the patient experienced onset and progression of muscle weakness limiting her motion and self-maintenance. After performing of investigation including electromyography steroid genesis of myopathy was suggested. The patient’s condition began to improve after disc ontinuation of glucocorticoids and administration of calcium supplements, vitamin D, and anabolics, and the patient was discharged.


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ISSN 2226-6704 (Print)
ISSN 2411-6564 (Online)