Regional Clinical Hospital No 4

Objective. To perform a comparative analysis of treatment compliance and efficacy in patients with type 2 diabetes mellitus who attended or did not attend the Diabetes School. Materials and methods. A prospective cohort study was conducted among 90 patients with type 2 diabetes, comprising 28 patients who attended the Diabetes School (DS) and 62 patients who did not attend the DS. The enrollment period was from October to November 2024. The observation period was 6 months. Routine clinical and laboratory assessments were supplemented by a questionnaire assessing the social status and the impact of the disease on quality of life. Morisky—Green and R.V. Kadyrov’s «Compliance level» questionnaires were used to assess compliance. Results. Patients who were trained in DS had more DM complications and worse glycemic control at baseline, with comparable compliance to treatment. After 6 months of follow-up, the number of patients with high compliance increased from 13 (46.4%) to 18 (64.3%) subjects (p=0.063), and the level of fasting glycemia improved (p=0.001). Patients who did not attend DS showed no change in the indicators of compliance and control of fasting blood glucose. Conclusions. Patients who attended or did not attend the Diabetes School showed similar compliance. Patients who received training showed a downward trend in fasting glycemia and an upward trend in treatment compliance.

Hypertension (HTN) is a serious public health problem. Despite advances in diagnosis and public awareness, the percentage of controlled cases remains low, especially among men and the elderly. The main challenges are related to comorbidities such as obesity, diabetes, chronic kidney disease, and obstructive sleep apnea, which worsen the prognosis and increase the risk of cardiovascular events. The approach to HTN treatment should be individualized and take into account specific disease phenotypes and comorbidities. It is important to identify patients with increased sympathetic nervous system activity, as this group experiences the greatest difficulties in blood pressure control. Moxonidine, a centrally acting agent, selectively stimulates imidazoline receptors in the brain, causing a decrease in sympathetic activity and effective reduction in blood pressure. The need for a personalized approach to HTN therapy is driven by the growing number of patients with multiple comorbidities and complex pathogenesis. New approaches, including early initiation of combination therapy and targeted management of metabolic risk factors, will reduce cardiovascular morbidity and mortality. Moxonidine plays a key role within antihypertensive medications due to its unique mechanism of action and ability to positively impact a wide range of HTN-related pathologies

Purpose: to study the clinical efficacy and safety of phacovitrectomy (PhEV) in the surgical treatment of rhegmatogenous retinal detachment (RRD). Materials and methods. We observed 146 patients (146 eyes) aged 34 to 77 years (mean age 56.4 ± 1.9 years). The inclusion criteria for patients in the study were: total RRD, complicated proliferative vitreoretinopathy (PVR) stages “B-C”, the presence of a native lens, no history of previous surgeries for RRD. All patients were divided into two groups equal in age, RRD localization and severity of PVR: the main group (MG, 74 patients, 74 eyes) — eyes that underwent PhEV; the control group (CG, 72 patients, 72 eyes) — who underwent only vitrectomy (VE). Comparative assessment of surgical safety was performed based on the incidence of intraoperative, early (up to 10 days) and late (1–3 months) postoperative complications. Comparative assessment of clinical efficacy of surgical intervention was performed based on the following parameters: anatomical retinal attachment, development of cystoid macular edema, and formation of epiretinal membrane. Results and discussion. The developed PhEV technique provides a higher level of safety and clinical efficacy of surgical treatment in patients with RRD, which is proven (compared to the group of patients who underwent only VE) by a decrease (on average, by 13.7, 4.1, 10.3 %) in the probability of intraoperative, early and late postoperative complications, as well as the incidence of cystoid macular edema and epiretinal membrane (p < 0.01). The main factor in intraoperative complications is a decrease (up to loss) in intraoperative visualization associated with the development of transient lens opacity. An increase in the incidence of cataract development in the CG during dynamic observation was noted from 16.7 % with an observation period of 10 days to 27.8 % with an observation period of 1–3 months. An almost identical and high (94.4–96.0 %) level of probability of anatomical reattachment of the retina was determined in patients of both groups. The higher level of safety and clinical effectiveness of PhEV (compared to VE) established in this work is explained by the significant advantages of the developed technique. Conclusion. The proposed PhEV technique can be recommended for the practice of surgical treatment of patients with RRD in accordance with the established indications.

This article, based on a literature review, presents current data on the role of innate immunity cells in the pathogenesis of coronavirus infection. The relationship between activation of various innate immune cells and the severity of COVID-19 is investigated. In particular, the role of neutrophils, lymphocytes, dendritic cells, NK cells and cells expressing HLA-DR in COVID-19 is considered. The review places emphasis on complex interaction between these cells in forming an effective immune response against SARS-CoV-2, as well as their contribution to inflammatory processes that can lead to severe course of the disease. Further research is needed to fully elucidate the mechanisms by which these cells contribute to both protection and pathology development in COVID-19, which will be crucial for the development of effective therapeutic strategies. This awareness will contribute to a better understanding of the immune response to SARS-CoV-2 infection and development of targeted therapies. The review also discusses the potential of modulating the innate immune response to improve clinical outcomes in patients with COVID-19. Finally, the article identifies areas where further research is needed to fully understand the complex interrelationship of innate immune cells in the context of SARS-CoV-2 infection.

Surgical treatment of aneurysms of the is a serious clinical challenge due to the complexity of surgical treatment. The method of hybrid surgical treatment using temporary balloon occlusion of the brachiocephalic trunk is the most optimal in open surgery, which optimizes the conditions for surgical intervention, minimizes the risks of intraoperative complications and affects the treatment outcomes.Patient M., 62 years old, was admitted to the vascular surgery department of the State Budgetary Healthcare Institution prof. S.V. Ochapovsky Research Institute — Regional Clinical Hospital No. 1 in June 2024 year with complaints of chest and spine pain of a girdle nature. Multispiral computed tomography with intravenous contrast revealed: aortic dissection type III B according to DeBakey - Belov, aneurysm of the right anterior aortic aneurysm.A hybrid surgical intervention was performed. The patient was offered a two-stage surgical treatment: thoracic aortic endoprosthetics with stent-graft implantation, resection of the aneurysm of the thoracic aorta and its prosthetic replacement. After implantation stent graft during CT dynamics in the early postoperative period revealed signs of endoleak stent graft Type I B. After 11 days, a repeat thoracic aortic endoprosthesis was performed with stent graft implantation. The endoleak was isolated.After 5 months, the patient underwent the second stage of treatment in the volume resection of the aneurysm of the cerebral artery, which, due to the anatomical features of the aneurysm of the cerebral artery, was performed using a hybrid method.The duration of the surgical intervention was 190 minutes. The anastomosis formation time was 20 minutes, and the occlusion time was 55 minutes. The volume of intraoperative blood loss was about 50 ml. The patient was extubated 10 minutes after the end of the operation on the operating table and transferred to the intensive care unit. The postoperative period was uneventful. On the 3rd and On the day after the operation the patient was activated and transferred to the general ward from the intensive care unit. On the 7th day the patient was discharged from the hospital in satisfactory condition.

The corneal graft rejection, especially in patients from the “high risk” group, is a complex immunological process that remains an urgent problem in ophthalmology. The cornea, despite its immunological privilege, loses its protective barriers under certain conditions (vascularization, inflammation), which leads to the development of immune reaction against the transplant. The key mechanisms of rejection include activation of T lymphocytes (CD4+ and CD8+), as well as an imbalance between effector and regulatory immune cells. Modern methods of immunological monitoring, including analysis of T cell populations, make it possible to detect signs of rejection in a timely manner and adjust therapy to improve long-term transplant results. The aim of our study was to conduct a comparative cytometric analysis of the population and subpopulation composition of blood lymphocytes in patients after end-to-end (penetrating) keratoplasty. The study involved 46 patients who underwent penetrating keratoplasty, being divided into two subgroups: those with transplant rejection (n = 25) and those with successful engraftment (n = 21), as well as a control group of 21 healthy volunteers. The immunological analysis included venous blood sampling and quantitative determination of lymphocyte subpopulations by flow cytometry using a Navios cytofluorimeter (Beckman Coulter, USA) and markers of CD45+ and CD46+ cell populations. Key populations of lymphocytes, including T helper cells, cytotoxic T lymphocytes, NK cells, B lymphocytes, and activated T cells, were studied to identify differences in the immune status of patients. Comparative cytometric analysis of the population and subpopulation composition of peripheral blood lymphocytes in “high-risk” patients with graft rejection showed a number of significant changes manifesting as an increased total number of T lymphocytes, T helper cells, T cytotoxic, T lymphocytes with markers of early and late activation, thus suggesting the key role of T cell-mediated immunity in development of late cellular rejection reactions. The data obtained suggest involvement of systemic cellular mechanisms into rejection of the native corneal allograft, presuming a need for a more detailed study of the T cell response of immune system in this condition. Cytometric assessment of subpopulations of immunocytes makes it possible to identify early signs of immune activation associated with rejection and opens up new opportunities for the development of personalized and effective treatment strategies aimed at improving the transplant outcomes.

Heart transplantation (HT) is a cardiac surgical procedure involving the replacement of a recipient’s pathologically impaired heart with a functionally adequate donor organ. As with any major surgical intervention, HT comes with possible complications, one of which is primary graft dysfunction (PGD). This report presents our initial experience in the diagnosis and management of a patient who developed PGD, necessitating the use of mechanical circulatory support.

Background: Despite the incorporation of neoadjuvant chemoradiotherapy into the standard treatment of locally advanced rectal cancer, significant variability in therapeutic response persists. This highlights the need for patient stratification using prognostic biomarkers. The identification of reliable morphological and immunohistochemical predictors of tumor resistance may enhance the effectiveness of personalized treatment strategies.Objective: To assess the prognostic value of cancer stem cell markers and components of the tumor microenvironment in predicting response to chemoradiotherapy in patients with locally advanced rectal cancer.Materials and Methods: The study included histological blocks obtained from biopsy and postoperative speciments of 75 patients with histoligically confirmed rectal adenocarcinoma who had undergone neoadjuvant chemoradiotherapy. Tumor regression grade (TRG) and immunohistochemical expression of ALDH1, TWIST, CD44, E-cadherin, LAG3, and CD20 were evaluated. Cut-off values were determined using ROC analysis. Associations between marker expression, clinicopathologic features, and treatment response were assessed. Results: A statistically significant association was found between poor response to chemoradiotherapy (TRG 2–3) and high expression of the following markers: ALDH1 >20% in 78.4% of patients (vs 26.3% in the TRG 0–1 group), TWIST >15% in 73.0% (vs 31.6%), CD44 >25% in 64.9% (vs 23.7%), LAG3 >10% in 64.9% (vs 28.9%), and CD20 >25% in 62.2% (vs 21.1%). Reduced E-cadherin expression (<30%) was observed in 62.2% of patients with TRG 2–3, compared to 23.7% in the marked morphological response group.Conclusions: Assessment of the expression levels of the pathomorphological markers ALDH1, TWIST, CD44, E-cadherin, LAG3, and CD20 represents a significant prognostic indicator of tumor response to chemoradiotherapy. Integration of a comprehensive evaluation algorithm may facilitate personalize treatment strategies for patients with locally advanced rectal cancer.

Introduction. The study was driven by the prevalence of secondary progressive multiple sclerosis (SPMS) in Russia and the lack of data on siponimod in the real clinical practice (RCP).Aim. To collect and analyze data on the administration of siponimod in SPMS patients within Russia’s RCP as part of the EMBOSSES study (rEtrospective Multicenter oBservatiOnal Study Siponimod rEal-world Spms).Materials and methods. The study encompassed data of 606 SPMS patients from 11 centers who received siponimod for at least 6 months. The analysed data included demographic and clinical characteristics of patients, changes in the Expanded Disability Status Scale (EDSS) scores over time, percentage of patients with 6-month confirmed disability progression (6mCDP), annualized relapse rate (ARR) for MS, radiological signs of the disease activity and adverse events (AEs).Results. Among the study patients, women predominated (64.9%), while men accounted for 35.1%. The median age of patients was 49.5 (±8.9) years. 143 (23.6%) patients reported relapses during 2 years, whereas relapse-free SPMS was observed in 463 (76.4%) patients. The average EDSS scores remained stable, demonstrating minimal changes from 5.44 (±0.998) to 5.58 (±1.028) scores during the 2-year therapy. The percentage of patients free from 6mCDP was 85.5%. The KaplanMeier analysis revealed that 25% of patients achieved 6mCDP by Month 27 of therapy. The average ARR decreased from 0.14 to 0.032 at 12 months and remained low (0.062) after 2 years of treatment. The MRI showed a decrease in the percentage of patients with Gd+ T1 lesions to their complete absence over 2 years of therapy. Main AEs: lymphopenia, bradycardia, and elevated liver enzymes; serious AEs were observed in 3.3% of all cases.Conclusions. Siponimod demonstrated efficacy in controlling disability progression and inflammatory activity, as well as a favourable safety profile in patients with SPMS in the RCP setting. The results confirm the feasibility of using siponimod in patients with SPMS.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by polysyndromic lesions of various organs and systems. Clinical manifestations of SLE may include lesions of the skin, joints, kidneys, serous membranes, and hematopoiesis system, which significantly complicates the diagnosis and management of patients. This paper presents three clinical cases demonstrating the variety of manifestations and severity of the course of SLE. In the first case, the disease debuted with a massive hydropericardium, which required surgical intervention. In the second case, the patient was observed for a long time with autoimmune nephritis, but later developed pulmonary embolism, which required correction of therapy. The third case was characterized by high activity of the disease with polyserositis, pancytopenia and severe skin manifestations, which required the use of genetically engineered biological therapy (GIBP). In the presented cases, a comprehensive examination of patients was performed, including immunological markers, instrumental diagnostic methods (CT, ECHO-CS, biopsy), as well as a differential diagnosis with hemoblastosis, vasculitis and other systemic diseases. The treatment was based on glucocorticosteroids (GCS), cytostatics (cyclophosphamide) and biological therapy (rituximab), which made it possible to stabilize the condition of patients and reduce the activity of the disease. Thus, the presented clinical cases illustrate the significant variety of clinical manifestations and the complexity of the diagnosis of SLE, which emphasizes the need for a multidisciplinary approach to the management of such patients. Modern therapies, including GIBP, make it possible to control the activity of the disease and improve the prognosis of patients with severe forms of SLE.