Uromodulin is a unique protein produced in the kidneys by epithelial cells of the ascending thick portion of the loop of Henle. It implements physiological mechanisms not only at the tubular level, but also participates in the coordination of general body processes. The main functions of uromodulin are an obstacle to prevent stone formation due to a violation of the aggregation of calcium salts and water reabsorption, coordination of electrolyte balance, and an obstacle to inflammatory processes locally and systemically. Moreover, the expression of uromodulin and its qualitative characteristics are under genetic control. In this regard, the pathology of the tubular apparatus or mutations in the genes encoding uromodulin lead to the development of primary or secondary tubulopathies with dysfunction of other organs and systems. At the same time, it is known that uromodulin is an incompletely studied protein both in terms of structure and features of the functions it performs. A thorough analysis of research data, including experimental work on the study of uromodulin in domestic and international literature sources, was carried out, with a presentation of the material in this manuscript.

Heart failure is an important medical, social and economic problem around the world. In recent years, a number of diagnostic and prognostic biological markers of blood in cardiovascular diseases have been studied. Identification of new biological markers, analysis of their pathophysiological aspects and changes in concentration under the influence of various treatment options, allow us to understand many pathogenetic features of the development and course of heart failure. In recent decades, natriuretic peptides have been introduced into clinical practice, which are widely used as reliable markers for diagnostic and prognostic assessment. Growth differentiation factor-15 is a cytokine belonging to the family of transforming growth factors, the activity of which is significantly increased under stress and inflammation. In patients with chronic heart failure, the concentration of this marker is associated with an increased risk of overall mortality and adverse cardiovascular events; in patients with heart failure with preserved left ventricular ejection fraction, the use of the marker showed prognostic and diagnostic significance. Data from the Framingham Heart Study showed that growth differentiation factor-15 was the only marker in multivariate analysis that showed a statistically significant association with all adverse cardiovascular events. Eight studies showed that overexpression of growth differentiation factor-15 was associated with an increased risk of mortality in patients with heart failure. It was shown that growth differentiation factor-15 as a prognostic marker in patients with acute heart failure is not inferior to the brain natriuretic peptide precursor. To confirm the value of this marker in blood in patients with heart failure, it is necessary to conduct extensive prospective randomized clinical trials.

The review contains information about the most common pathogens of infective endocarditis (IE) in certain categories of patients. Basing on analysis of current national and foreign sources concerning IE study there are description of conditions favoring to dominance of various microorganisms in intravenous drug users, HIV-infected patients, patients on hemodialysis, with valve prostheses, diabetes mellitus and malignant neoplasm patients, elderly patients, and pregnant women.

Distribution of both as typical for IE (staphylococci, streptococci, enterococci) and rare microorganisms as well polymicrobial endocarditis in mentioned above groups is considered. There is discussion about possible reasons of prevalence of methicillin-sensitive or methicillin-resistant Staphylococcus aureus species in different IE patient categories, disease development initiated by rare forms of microbial agents in immunosuppressive patients, microbial flora features depending on terms valvular infection after valve prosthetics. Despite on consideration about predominance of one or another microorganism as an etiologic agent of IE in given clinical situation, during medical help providing it should strive for precise verification of an etiologic factor for choice of effective antibacterial treatment.

Hodgkin’s lymphoma is more common in the younger patient population. An increase in overall and recurrence-free survival increases the likelihood of developing post-cytostatic complications in the form of a decrease in bone mineral density and associated low-energy fractures.

The aim of the work is to evaluate risk factors for bone mineral density decrease in patients with Hodgkin’s lymphoma after standard polychemotherapy and autologous hematopoietic stem cell transplantation.

Material and Methods: The study included 118 people, of which 88 people were patients with Hodgkin’s lymphoma and 30 people were the control group. The study group of patients with Hodgkin’s lymphoma was divided into 2 groups: patients who received standard polychemotherapy and patients who received standard polychemotherapy and autologous hematopoietic stem cell transplantation. For all patients, measurements of bone mineral density were performed using the HologicDiscovery QDR scanner (USA) in the lumbar spine (L2–L4) and in the thigh region (total area of t he thigh and femoral neck). The minimum measurements of bone mineral density and T-scores in the hip and femoral neck were selected, and the Z-score was calculated for young patients.

Results: According to the results of densitometry in both study groups, there was no decrease in bone mineral density below the age norm. In 13 patients (30 %) who received autologous hematopoietic stem cell transplantation, a decrease in T-score was found, which corresponds to osteopenia and osteoporosis. In the standard PCT group, a decrease in the T-criterion was observed in 6 patients (14 %): to stagnation — in 3 patients (7 %), to osteoporosis — in 3 patients (7 %). All patients with Hodgkin’s lymphoma included in the study received high doses of glucocorticosteroids. There was no correlation between the decrease in BMD, Z-criterion and the risk of low-energy fracture on the stage and variant of the disease.

Conclusion: The high incidence of bone density reduction, taking into account a favorable prognosis for the life of patients with Hodgkin’s lymphoma, indicates the need to develop schemes for the prevention of osteoporosis and osteopenia.

The study aims to neurological and functional recovery in patients after ischemic stroke depending on blood pressure (BP) parameters and its variability.

Materials and methods: We examined 150 patients with ischemic stroke and arterial hypertension (AH) who were hospitalized in the neurological department (76 (50,7 %) men and 74 (49,3 %) women, mean age 67,4±7,3 years). All patients underwent standard physical and laboratory examinations, measurement of blood pressure in dynamics; The National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of neurological deficits at the time of admission to the hospital, in the dynamics of the acute period (up to 21 days) and on the 21st day.

Results: It was found that the consequences of the acute period of stroke depend on the level of blood pressure and its variability at the beginning of the ac ute period. A more  than 50 percent probability of a decrease in the NIHSS score by half (from baseline) is predicted if the patient has a standard deviation (SD) systolic blood pressure (SBP) less than 12,4 mm Hg on days 1–3. In addition, SD SBP on days 1–3 and 1–6 days, and SD diastolic blood pressure (DBP) from 1 to 3 days are the most significant in assessing the relationship with the degree of functional impairment at the end of the acute period of stroke.

Conclusion: The level of blood pressure and its variability during the acute period of ischemic stroke makes it possible to predict the severity of the neurological deficit and the functional consequences of stroke in the recovery period (up to 21 days). 

Patients with chronic liver diseases (CLD) are at high risk of infection and severe COVID-19 (Corona Virus Disease).

Aim: to create a database of patients with CLD, including an analysis of the frequency of detection of SARS-CoV-2 markers, the causes of hospitalization, an assessment of 30-day mortality in the presence of COVID-19 markers and in the absence of infection.

Materials and methods. A one-time retrospective observational comparative study was conducted, the result of which was the creation of a database. 693 electronic case hystories of patients with CLD of various etiologies hospitalized in the V.M. Buyanov State Clinical Hospital for the period 01.04.2020–01.10.2021 were analyzed. Th e analysis included the following parameters: gender, age, etiology of the disease, reasons for hospitalization, the presence of ribonucleic acid (RNA) SARS-CoV-2 in a smear of the nasal mucosa and oropharynx, antibodies to SARS-CoV-2 immunoglobulins of classes M, G (IgM, IgG), the outcome of the disease (30-day mortality).

Results. Markers of past new coronavirus infection (IgG) were detected in 268 (38,7 %), SARS-CoV-2 RNA was detected in 67 (9,7 %). Th e analysis of the causes of hospitalization revealed the predominance of edematous ascitic syndrome (64,5 %), an increase in hepatic encephalopathy (31,6 %) and an increase in the number of cases of portal vein thrombosis (PVT) (8,9 %). When assessing the 30-day mortality, signifi cant diff erences were found in patients with Alcohol-related liver disease (ARLD), chronic viral hepatitis in the presence of COVID-19 markers and in cases of their absence.

Conclusion. SARSCoV-2 markers were found in 335 (48,3 %) of patients with CLD. Th e main reason for hospitalization is the appearance /increase of edematous ascitic syndrome, including due to PVT. 30-day mortality in the postcovid period is signifi cantly higher (р = 0,0246) in ARLD compared with patients without COVID-19 (218 (34,9 %) и 300 (25,3 %), respectively, р = 0,0246).

Purpose of the study. To assess the sensitivity, specificity and diagnostic accuracy of the method for non-invasive differential diagnosis of liver diseases by polyhepatography.

Materials and methods. A random sampling method examined 45 primary patients. Polygepatography was performed on all patients to detect disorders of intrahepatic microcirculation during primary contacting. Based on the detected changes in intrahepatic hemodynamics and based on the morphofunctional hemodynamic model, a conclusion was made about the violation of intrahepatic blood flow and an assumption was made about the etiology and stage of liver disease. Subsequently, the diagnosis of liver diseases was verified after a detailed study of clinical-laboratory, instrumental and morphological data generally accepted in hepatology. Puncture liver biopsy by the Mancini method was performed in 11.1 % of the subjects.

Results. All subjects were divided into three groups based on the data obtained on impaired intrahepatic hemodynamics during polyhepatography (PHG). The group I consisted of patients with impaired venous inflow, the group II included patients with impaired arteriovenous inflow, and group III — with impaired venous outflow. The obtained polyhepatographic data were compared with the results of clinical-laboratory, instrumental and morphological data. The high sensitivity, sufficient specificity and accuracy of the polyhepatography method in the diagnosis of chronic liver diseases have been determined.

Conclusion. The studies carried out indicate that PHG is a simple, accessible and not burdensome examination method for the patient, which makes it possible to assess the localization of intrahepatic blood flow disorders, and, with a certain degree of probability, to assume the etiological factor of the disease and the stage of the disease. Given the specificity of changes in liver hemodynamics, de pending on the etiological factor and stage of the disease, assessment of intrahepatic hemodynamics by polyhepatography can be recommended as a screening method for examining patients with liver diseases, which will shorten the diagnostic search time.

The purpose of the study — to identify and evaluate the clinical significance of “hidden” disorders of blood oxygenation in smokers with exacerbation of bronchial asthma.

Materials and methods: spirometry, pulse oximetry, CO-metry of exhaled air. To diagnose “hidden” disorders of blood oxygenation, including “hidden” violations of the spectral characteristics of the level of hemoglobin oxygen saturation, 19 male smokers (middle age 54,6±2,05 years) with exacerbation of mixed (68 %) or allergic (32 %) bronchial asthma were examined.

The results: the accuracy of the clinical assessment of blood oxygenation in smokers increased significantly after the correction of the SpO₂ level to the level of carboxyhemoglobin with the help of a computer program developed by us, which made it possible to diagnose a clinically significant lifethreatening exacerbation of this disease in smoking patients with bronchial asthma, since “hidden” respiratory insufficiency was detected in a timely manner.