Stavropol Regional Clinical Oncology Center

The level of antimicrobial peptides, which affects the course of the infectious process, depends on the concentration of vitamin D in the blood serum. The analysis of anthropometric and laboratory data in 90 premature newborns was carried out in the Stavropol Regional Clinical Perinatal Center and Stavropol Regional Clinical Perinatal Center № 1. Calcidiol medina in the study group was 17.9 [12.2; 23.3] ng/ml. At the same time, 54 (60 %) infants had 25(OH)D deficiency. Premature newborns who did not have an infectious process had a statistically significantly higher median calcidiol than infants who had congenital pneumonia and died (20.

Despite the presence of numerous publications and analytical reviews in the foreign literature, there is no universally accepted algorithm for the surgical treatment of Chiari I malformation (MC I) in children. Moreover, in the domestic literature, the number of publications devoted to the problems of surgical treatment of MC I in children is significantly limited, which, in our opinion, this is the reason for the relevance of this work. To study the results of surgical treatment of children with MC I when applying differentiated tactics of intraoperative choice of intervention volume. The results of neurological examination and surgical treatment of 43 patients aged from 1 to 17 years (mean age 8.48 years) were analyzed. The decision on the need for duraplasty was made intraoperatively when signs of persisting compression of subarachnoid spaces after extradural decompression were detected. Clinical manifestations were assessed according to neurological data before discharge, as well as in long-term period with a follow-up from 6 months to 5 years via survey. Duraplasty was required in 28% of cases. Respiratory disorders disappeared in all patients immediately after surgery and were absent thereafter. Positive dynamics was noted in terms of restoration of the rate of speech development. Headache persisted in 7 (21%) patients, movement, sensation disorders and cerebellar symptoms - in 4 (12%), vomiting and bulbar symptoms - in 2 (6%) patients. There was no difference in the efficacy of surgery with and without duraplasty. None of the parameters evaluated preoperatively had a significant association with the intraoperative decision on the need for duraplasty. In our opinion, final decision on surgical strategy in children with Chiari malformation type I should be made considering intraoperative assessment of extradural decompression. The last one is probably associated with individual characteristics of patients.

Background: The pathogenesis of slow/no-reflow phenomena is a critical socio-medical problem due to high mortality and work disability rates in patients with ST-segment elevation myocardial infarction (STEMI). Slow/no-reflow phenomena are multifactorial involving 4 key elements: 1) distal embolization of the coronary bed of the infarct-related coronary artery; 2) ischemic damage to the myocardium; 3) reperfusion injury of the heart muscle; 4) individual (genetic) susceptibility of the microcirculation to injury. Objective: To analyze the outcomes of percutaneous coronary interventions (PCI) in patients with STEMI and TIMI 0 blood flow of an infarct-related coronary artery based on the strategy to restore antegrade blood flow (balloon predilation or dilation of an infarctrelated artery). Materials and methods: We analyzed treatment outcomes of 209 patients with STEMI and TIMI 0 blood flow. The patients were grouped based on the PCI strategy: group 1 included 147 patients who underwent balloon angioplasty to restore antegrade blood flow, and group 2 included 62 patients who underwent dilation of an infarct-related coronary artery. Results: Our study found that direct stenting in STEMI patients was associated with statistically significantly lower risk of slow/noreflow phenomena (P = 0.001, Pearson’s χ2) and, as a result, better functional outcomes of treatment (chronic heart failure grade classified according to Strazhesko-Vasilenko and by left ventricular ejection fraction) that were also statistically significant (P = 0.001, Pearson’s χ2). Conclusions: Our study demonstrated that the risk of slow/no-reflow phenomena in patients with TIMI 0 blood flow of an infarctrelated coronary artery was statistically significantly lower (P = .001, Pearson’s χ2) in the group of patients who underwent dilation of an infarct-related coronary artery to restore antegrade blood flow. Functional outcomes (chronic heart failure grade and overall survival) were also better in this group of patients (P = .001, Pearson’s Chi-square). Moreover, dilation of an infarct-related coronary artery was associated with preserved left ventricular ejection fraction compared with the group of patients who underwent balloon angioplasty to restore antegrade blood flow (P < 0.001, Pearson’s χ2).

Hypothyroidism is a clinical syndrome caused by hypofunction of the thyroid gland and characterized by a decrease in the content of thyroid hormones in the blood serum.Clinical manifestations of hypothyroidism can be diverse and depend on its etiology, the age of the patient, as well as the rate of development of thyroid hormone deficiency.The disease may have a pronounced clinical picture or, conversely, have no clinical manifestations and be detected randomly.Moreover, the signs of hypothyroidism very often mimic (mask) another pathology.Therefore, the diagnosis of hypothyroidism in some cases is difficult.In this work, a systematic analysis of the literature and clinical studies was carried out, and the negative effect of hypothyroidism in a patient on the liver, biliary system and pancreas was established.When analyzing the effect of hypothyroidism on the liver, no changes were observed in the organ itself.However, serum enzymes increased, such as aspartate aminotransferase, lactate dehydrogenase, and creatine phosphokinase.Violation of lipid metabolism in the liver with hypothyroidism can lead to obesity, which is never significant.Hypothyroidism revealed a violation of the biliary system and the development of cholelithiasis.There is a scientific study on the relationship between hypothyroidism and the formation of stones in the common bile duct.

ВИТАмИН d КАК мАРКЕР НЕАЛКОГОЛьНОЙ ЖИРОВОЙ БОЛЕЗНИ пЕчЕНИ у БОЛьНЫХ САХАРНЫм ДИАБЕТОм 2 ТИпА А. В. Ягода 1 , п. В. Корой 1 , Е. О. Демурчева 2 , Н. Е. Хваталин 1 , А. Д. Светогурова 1 , В. Д. Саритхала 1 1 Ставропольский государственный медицинский университет, Российская Федерация 2 Краевой эндокринологический диспансер, Ставрополь, Российская ФедерацияNinety patients with type 2 diabetes mellitus (DM) aged 39 to 76 years were examined.Women were 71 (78.9 %), men -19 (21.1 %).The diagnosis of non-alcoholic fatty liver disease (NAFLD) was made based on an ultrasound examination of the abdominal cavity.The levels of vitamin D in the blood were determined by enzyme immunoassay.NAFLD was detected in 66.7 % of patients with type 2 DM.Vitamin D levels in the blood of patients with NAFLD on the background of type 2 DM were lower, and its deficiency was more common than in cases of DM without NAFLD.Serum vitamin D levels in patients with NAFLD and cholestatic syndrome were lower than in cases of NAFLD without signs of cholestasis.According to regression analysis, the development of NAFLD in type 2 DM is affected by reduced vitamin D levels in the blood and increased values of glucose, alanine aminotransferase, and low-density lipoproteins.Thus, the development of NAFLD against the background of type 2 DM is associated with a decrease in vitamin D concentration in the blood.Serum level of vitamin D less than 16.18 ng/ml can be used as a predictor of NAFLD in patients with type 2 DM.

A clinical case of recurrent polychondritis with damage to the cardiovascular system in the form of the development of acute coronary syndrome is presented. Recurrent polychondritis is a rare systemic presumably autoimmune disease that is affecting cartilage tissue. The main cause of high mortality in patients with systemic diseases is the early formation and accelerated progression of atherosclerotic vascular lesions that cause the development of myocardial infarction, stroke, chronic heart failure and sudden death. Recurrent polychondritis is characterized by clinical polymorphism. The diagnosis of the disease requires the interdisciplinary medical participation of at least five specialists.

Relevance. There is no doubt that microorganisms participate in occurrence and development of septic process in joints. However, the issue of etiological significance of each agent remains controversial, because, in spite of the general trends, indicating the participation of numerous microorganisms in the development of articular pathology, each result of microbiological analysis concerns only a specific case in the territorial and clinical aspects. The aim of the study - microbiological research of synovial fluid obtained from knee joint during synovitis after its aspiration in patients of various departments of the Stavropol Regional Clinical Hospital. Materials and Methods . There were studied 198 samples of synovial fluid. Primary inoculation of puncture was performed with subsequent isolation, identification of the cultures by mass spectrometry and assessment of their antibiotic sensitivity by discodiffusion method. Results and Discussion . 11 cultures of bacterial pathogens were isolated. Gram-positive cocci - 82 %, of which 77.8 % - microorganisms of Staphylococcus genus (44.4 % S.aureus , 33.4 % S.epidermidis ), 22.2 % - other gram-positive cocci: one strain of each, Enterococcus faecium and Streptococcus mitis . Gram-negative pathogens are represented by K.neumoniae and P.aeruginosa with a total content of 18 %. Highly virulent microorganisms S.aureus , K.neumoniae and P.aeruginosa are isolated from the synovial fluid of patients of the surgical departments (orthopedotraumatological No. 1, No. 2) and the rheumatological department. Microorganisms with low virulence E.faecium , S.mitis and S.epidermidis are isolated from synovial fluid of patients of various departments. No obvious resistance of isolated pathogens to antimicrobial drugs has been registered. Conclusion . The presence and species affiliation of the microorganisms identified in synovial fluid allows predicting their etiological significance in development of septic process in joints. Their role as causative agents of nosocomial infections typical for a medical institution is not excluded. The presence of articular pathology in each of the examined departments dictates the need for a clear understanding of the importance of timely and high-quality joint aspiration followed by microbiological examination in almost all patients with damage of large joints, including patients without clinical signs of septic arthritis. Such an approach that makes it possible to identify a greater number of causative agents of septic arthritis and quickly evaluate the dynamics of their antimicrobial resistance should become an obligatory part of a comprehensive research and treatment of a patient with arthritis in multi-fi eld hospitals.

Introduction: Bulevirtide (BLV) is a first-in-class entry inhibitor for the treatment of chronic hepatitis D virus (cHDV) infection. BLV has shown pronounced virologic and biochemical responses in two Phase 2 trials. We present findings of a predefined 24-week interim analysis of the MYR301 Phase 3 study in HBV/HDV co-infected patients receiving 2 or 10 mg qd BLV monotherapy in comparison to no antiviral treatment. Methods: 150 patients with cHDV infection were randomized 1:1:1 to no antiviral treatment for 48 weeks followed by 10 mg qd BLV for 96 weeks (arm A, n=51) or to 2 mg qd BLV (arm B, n=49) or 10 mg qd BLV (arm C, n=50) for 144 weeks with a 96-week treatment-free follow-up. The primary endpoint, combined response, was defined as undetectable HDV RNA (< LoD) or decrease by ≥2 log10 IU/mL and ALT normalization at week 48; secondary endpoints included undetectable HDV RNA, decline by ≥2 log10 IU/mL, ALT normalization, and HBsAg decline by ≥1 log10 IU/mL. Results: Owing to a communications embargo, Week 48 data were not available for this submission. We will include those data for presentation of this abstract at the ACG conference. Patient characteristics: 57% were male, 83% were white, mean age was 42 years. Baseline HDV RNA levels were 5.05 log10 IU/mL; mean ALT was 110.9 U/L. BLV was well tolerated over the first 24 weeks; 421 treatment-emergent adverse events (TEAE) were reported: 55 TEAEs in 26 patients in arm A, 121 TEAEs in 32 patients in arm B, and 245 TEAEs in 36 patients in arm C. 48 TEAEs in arm B and 100 in arm C were assessed as possibly related to BLV. One serious TEAE was reported in one patient in arm A. At week 24, the proportions of patients achieving combined virologic and biochemical response were 37% in arm B and 28% in arm C (vs 0% in arm A, p< 0.0001). An HDV RNA decrease by ≥2 log10 IU/mL at week 24 from baseline was observed in 55% of patients in arm B and 68% in arm C (vs 4% in arm A, p< 0.0001). At week 24, ALT normalization was reached by 53% of arm B and 38% of arm C (vs 6% of arm A, p< 0.0001). One patient treated with 2 mg BLV achieved an HBsAg reduction ≥1 log10 IU/mL at week 24. Conclusion: This Phase 3 trial confirms that monotherapy with BLV is safe and well tolerated in patients with compensated cHDV infection. 24 weeks of treatment with BLV was associated with significant HDV RNA declines and improvements in biochemical disease activity. These findings further support the conditional approval of BLV.