LECTURES
All creative people, whose names we remember, are united by such a character trait as passion. And the field of creativity is not so important here — both in art, and in technical sciences, and in medicine, to achieve a result, complete immersion in research, some kind of obsession is necessary. Robert Koch (1843-1910) — a great researcher, a German physician, microbiologist and hygienist, proved by his own example that a clear goal, fortitude and efficiency overcome all unfavorable circumstances. This work examined the life and work of Robert Koch over a significant period of time — from graduation to the discovery of tuberculin, its announcement as a treatment for tuberculosis and the recognition of the fallacy of this statement. From the point of view of the authors of the work, this period of time is of great interest. We see Robert Koch — a scientist with extraordinary abilities and a unique combination of character traits. Diligence and the highest ability to work, exactingness towards himself, a clear organization of work, the ability not to stop in the face of difficulties — predetermined the success of his research.
REVIEW ARTICLE
Modern concepts about the «inflammaging» and the role of subclinical inflammation in various age-associated pathology are described in the review. Particular attention is paid to the tumor necrosis factor-α, a key cytokine that plays an important role in the pathogenesis of chronic inflammatory diseases as well as in aging. The increased levels of tumor necrosis factor-α leads to the onset and progression of various diseases, to severity of frailty, to disability and mortality of elderly persons. Tumor necrosis factor-α affects different risk factors for cardiovascular diseases, contributes to the onset and progression of atherosclerosis and related pathology. This cytokine can also aggravate various metabolic disorders, mainly — insulin resistance and diabetes mellitus. Tumor necrosis factor-α is a key cytokine that stimulates bone resorption (up to osteoporosis) and sarcopenia (up to cachexia). Currently available data confirm the important role of tumor necrosis factor-α in various age-associated disorders.
The variety of dermatological manifestations in patients with the novel coronavirus infection COVID-19, the incidence of which depends on concomitant pathology and the characteristics of drug treatment, and their characteristics are similar to those that occur with conventional viral infections is discussed. At the present time it is proposed to distinguish several groups depending on the cause and mechanism of development: angiitis of the skin; papulo-squamous rash and pink lichen; measles rash and infectious erythema; papulo-vesicular rash; toxidermia; urticarial eruptions and artifical lesions. The variety of the clinical picture of the skin manifestations of coronavirus infection requires in-depth analysis in order to interpret correctly the skin lesions and other infectious exanthema and dermatoses in patients with COVID-19.
Cardiac amyloidosis (amyloid cardiomyopathy) is a disease damage to the heart caused by extracellular amyloid deposition. In some cases, there may be local damage to the structures of the heart, for example, the atria; more often, heart damage is part of a systemic (generalized) pathology. Depending on the amyloid precursor protein, 36 types of amyloidosis are described, among which hereditary and acquired forms are distinguished. Cardiac amyloidosis is diagnosed 1) in the case of the amyloid infiltration in the myocardial bioptates or 2) in the case of non-cardiac amyloid deposition and the left ventricular wall thickening >12 mm without arterial hypertension and other reasons. The heart is most often affected in AL-, ATTR-, AA-, AANF-types of amyloidosis. Cardiac amyloidosis should be considered in patients with a heart failure with an unclear etiology, especially with preserved left ventricular ejection fraction, refractory to treatment, with proteinuria and CKD 4-5, in patients with idiopathic atrial fibrillation and conduction disturbances, in patients with left ventricular wall thickening of unclear etiology, low ECG voltage, unexplained arterial hypotension and pulmonary hypertension. Screening for cardiac amyloidosis should include non-invasive methods such as electrophoresis and immunofixation of blood and urine proteins, the free light lambda and kappa chains of immunoglobulins, 99Tc-DPD scintigraphy, genetic testing (if hereditary variants of amyloidosis are suspected), as well as a histological examination of biopsy samples stained with Congo red and polarizing microscopy.
ORIGINAL ARTICLES
Obstructive sleep apnea (OSA) is diagnosed in 25% of adults and associated with high fatal risks of cardiovascular complications. Left ventricular hypertrophy (LVH) is recognized as one of the markers of such risks. In this study, we attempted to create a mathematical model for predicting LVH among OAS patients with various levels of disease severity.
Materials and methods. In a prospective cohort study, we included 368 patients (358 male; age 46.0 [42.0; 49.0] yr.) with diagnosed OSA, arterial hypertension, grade I-II obesity (WHO classification 1997). The severity of sleep apnea was verified during nighttime computed somnography (CSG) on WatchPAT-200 hardware (ItamarMedical, Israel) with original software zzzPATTMSW ver. 5.1.77.7 (ItamarMedical, Israel) by registering the main respiratory polygraphic characteristics from 11.00 PM to 7:30 AM. Verification of LVH was performed in one- and two-dimensional modes in standard echocardiographic positions using Xario-200 ultrasound scanner (Toshiba, Japan) with 3.5 MHz transducer. Hemodynamic parameters of left ventricular (LV) systolic function (EF %, ESV, EDV) were determined by quantitative assessment of two-dimensional echocardiograms using the modified Simpson method. Evaluation of the systolic function of the right ventricle (RV) was performed in the «M»-mode by measuring the systolic excursion of the fibrous ring of the tricuspid valve (TAPSE).
Results. ESS and TSat90% (AUC = 0.975; SD = 0.00741; CI 95% [0.953; 0.988]) should be considered the best predictors for predicting LVH in various degrees of OSA severity, allowing us to offer a predictive model with a sensitivity of 93.7% and specificity of 93.8%, after conducting a questionnaire screening and computer somnographic study.
Conclusions. Our proposed model of clinical prediction of LVH among patients with various degrees of OAS is based on a carefully planned analysis of questionnaire and instrumental data, and is well applicable in real diagnostic procedures by a wide range of therapeutic practitioners.
The aim. A comprehensive study of the functional state of the small intestine and the study of the relationship of its disorders with the development of non-alcoholic fatty liver disease.
Materials and methods. 86 patients with non-alcoholic fatty liver disease at the stage of steatosis and steatohepatitis were examined according to the results of ultrasound examination of the liver using the SONIX OP apparatus (Canada) and the FibroMax test of BioPredictiv company (Paris, France). Patients underwent a blood glucose test using an Huma Star 600 analyzer (Germany) and insulin using an enzyme-linked immunosorbent assay. The HOMA-IR insulin resistance index was calculated. In order to determine abnormal digestive disorders in the small intestine, a stress test was performed with soluble starch, membrane digestion with sucrose, absorption with glucose. IDBs were evaluated using a hydrogen breath test on a LactofN2 apparatus from the AMA firm (St. Petersburg). To assess colonic microflora, stool was sown for dysbiosis.
Results. According to clinical data, in patients with non-alcoholic fatty liver disease, damage to the small intestine occurs in a non-manifest form. However, in the study of the functional state of the small intestine in patients, a significant decrease in cavity and membrane digestion, increased absorption are detected. In patients with non-alcoholic fatty liver disease, an increase in blood insulin was observed compared with the control group (16,64±0,78 μIU/ml versus 10,46±0,56 μI/ml, p=0,000002). The HOMA-IR insulin resistance index was also increased in patients compared with the control group (2,84±0,11 versus 2,05±0,07, p=0,00003). Excessive bacterial growth was diagnosed in 62 (72%) of patients with non-alcoholic fatty liver disease, while with liver steatosis — in 33 (55%), with steatohepatitis 1 degree of activity — in 11 (61,1%), with steatohepatitis 2 degrees — in 6 (66,7%), with steatohepatitis 3 degrees — in 2 (100%) of patients. According to the results of stool stool, dysbiosis was detected in 56 (65,1%) of patients with non-alcoholic fatty liver disease. A correlation analysis revealed negative relationships between the severity of excessive bacterial growth and digestive digestion, between the severity of excessive bacterial growth and membrane digestion, and a positive relationship between the severity of excessive bacterial growth and absorption.
Conclusion. Non-alcoholic fatty liver disease is accompanied by disorders of the digestive and resorptive functions of the small intestine, and the development of dysbiosis. These disorders are often subclinical in nature and can be identified and evaluated after special studies.
The effectiveness of the treatment of acute tonsillitis directly depends on the etiological diagnosis and adherence to the principles of rational etiotropic antibiotic therapy. Currently, streptococcal genesis of inflammation is considered as the only indication for the appointment of systemic antibiotic therapy. The article presents the results of clinical and statistical analysis of calls to patients with acute tonsillitis and express diagnostics of streptococcal infection using «Streptatest». For the period from 30.07.2018 until 30.11.2018 Doctors of the emergency department teams for adults and children performed express diagnostics of group A β-hemolytic streptococcus in 252 patients with acute tonsillitis complaining of «sore throat», whose age ranged from 3 to 44 years. This rapid diagnostic system «Streptatest», based on the method of immunochromatographic analysis, made it possible to identify as early as possible in 117 (46.4%) patients β-hemolytic streptococcus group A and promptly prescribe etiotropic antibiotic therapy to them. The second group consisted of 135 (53.6%) patients with a negative result of the «Streptatest» rapid test. In the group with a positive result of the express test, the main part was made up of children of preschool and school age — 92 (78.6%) patients. In 114 (97.5%) patients with diagnosed group A β-hemolytic streptococcus, clinical symptoms according to the McIsaас modified Centor scale were rated from 3 to 5 points. Early etiological verification of acute tonsillitis made it possible to follow the strategy of preventing the sp read of antimicrobial resistance and reducing the resistance of microorganisms to antibacterial drugs.
ISSN 2411-6564 (Online)