Etiopathogenesis of non-exudative age-related macular degeneration (literature review)

The article presents an overview of modern publications on epidemiology, risk factors, and the main links of the etiology and pathogenesis of age-related macular degeneration (AMD). The nonexudative or “dry” form of age-related macular degeneration is a multifactorial progressive pathological process caused by hereditary predisposition, general and local disorders of lipid metabolism, negative changes in  the blood supply to the eye, age-related destruction of the Bruch’s membrane and retinal pigment epithelium, the appearance of signs of local and systemic inflammation, the development of oxidative stress with the impact of toxic lipoperoxidation products on the structures of the posterior segment of the eye. Recent studies have discovered new ways of retinal pigment epithelial cell death in response to oxidative stress in AMD, in particular necroptosis, which, in addition to classical apoptosis, is considered the main mechanism of this process. It is noted that the development of AMD may be associated with an age-related decrease in the level of estrogen in women. The analysis of the data on the etiopathogenesis of age-related macular degeneration presented in the modern literature indicates the need for further research and generalization of local and general pathological processes developing in the dynamics of retinal visual function disorders by specialists of various scientific disciplines

"West"-"East" in the tatar national literature

Determining actuality and prospects of system analysis and comparing Western European and Arab - Persian prose translated and adapted into Tatar language in the period of the end of XIX- the beginning of XX centuries, summarize and identify the influence the Tatar national literature in the context of " West"-"East". It should be made the analysis and to define degree of similarity some originals with their versions in Tatar in genre aspects, architectonics and poetics of a literary text, to show the important of literary narration both in the theoretical and historic-literary scale. It is also necessary to reveal peculiarities of translation poetics, especially using of translated lexica-semantic, stylistic units. © IDOSI Publications, 2014

Features of morphological and ultrastructural organization of the cornea (literature review)

The human cornea – the anterior fibrous membrane of the eye, is a unique ordered optical-biological system that is avascular, saturated with nerve endings, includes tissue-specific cells, consists mainly of various types of collagen. An exceptional feature of the collagen layers of the cornea, including the collagen plates of the stroma, is transparency, which provides physiological refraction and light transmission due to the stable supporting properties of the cornea. The data on the morphological structure of the cornea, which is an important element of the optical system of the eye, are of considerable interest not only from theoretical, but also from practical positions. This is due to the fact that the identification of the first signs of deviation from normal physiological morphological and ultrastructural criteria in the cornea allows us to establish the nature of its pathological changes, which can be caused by both hereditary predisposition and local and general disorders. It has been shown that the thinning of the layers of the cornea, a decrease in the density of endotheliocytes or keratocytes signal the development of dystrophic processes in it. In addition to evaluating quantitative morphometric data, changes in qualitative ultrastructural indicators play an important role. In particular it was found that a decrease in the density of endothelial cells is accompanied by an increase in their size and a decrease in the cell nucleus. In addition, a number of degenerative pathological conditions are characterized by a decrease in the diameter of collagen fibrils and a change in the density of fibrillary packaging.This literature review presents basic information, features of morphology, ultrastructural organization and functional purpose of layers and cells of the human cornea

The advisory board resolution on the use of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in type 2 diabetes

Type 2 diabetes is characterized by increasing incidence and prevalence all-over the world. Current therapeutic management of type 2 diabetes is complex and is based not only on glycemic control, but also on cardiovascular and renal risks reduction. In previous years the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) increased in Russian Federation. Some manufacturers of the most widely used GLP-1 RA reported the supply decline in several countries. On Advisory board with participation of the Russian Endocrinology Association members the topics of SGLT2i and GLP-1 RA use in type 2 diabetes were discussed. The experts made conclusion that the decrease in access to GLP-1 RA does not pose serious risk for treatment of type 2 diabetes patients. SGLT2i show benefits in risk reduction of HF and CKD progression compering to GLP-1 RA, and in general show comparable efficacy in risk reduction of ACVD outcomes.  SGLT2i show less glycemic efficacy in comparison with GLP-1 RA, and their replacement may need adding antidiabetic agents from other groups

Draft of Russian Clinical Practice Guidelines «Male hypogonadism»

Hypogonadism in males, defined as a decrease in serum testosterone levels in combination with characteristic symptoms and/or signs, can be observed with pathological changes in the testicles and/or pituitary gland, such as Klinefelter’s syndrome, Kallman’s syndrome, as well as in men with metabolic (obesity, diabetes mellitus) or iatrogenic disorders leading to a decrease in androgen production. The draft guidelines cover the extensive range of pathologies that cause hypogonadism development (testosterone deficiency) and focus on its clinical variants, which make up the majority of cases of hypogonadism observed in men. The authors and reviewers are an interdisciplinary group of experts, consisting of endocrinologists, andrologists, urologists - members of the «Russian Association of Endocrinologists» and «Men’s and Reproductive Health» public organizations.Clinical guidelines contain the most reliable evidence available to experts at the time of writing. Nevertheless, recommendations cannot replace clinical experience, and deciding on the start of treatment, choosing a method of therapy, or a drug should always consider the individual characteristics of a specific patient

СРАВНИТЕЛЬНАЯ ХАРАКТЕРИСТИКА ПЕРИОДОВ ПОДДЕРЖАНИЯ АНЕСТЕЗИИ И ПОСЛЕНАРКОЗНОГО ПРОБУЖДЕНИЯ ПРИ АНЕСТЕЗИИ НА ОСНОВЕ СЕВОФЛУРАНА И ДЕСФЛУРАНА В АМБУЛАТОРНОЙ ХИРУРГИИ

Objective: to study the specific features of sevoflurane and desflurane-based anesthetic maintenance and awakening periods in outpatient surgery. Subjects and methods. The course of intraoperative and immediate postoperative periods was analyzed in 125 patients. By using the envelope method, the patients were randomized to one of two study groups according to the mode of anesthesia: 1) desflurane-based anesthesia (n = 62); 2) sevoflurane-based anesthesia (n = 63). Results. During surgery, all group 1 patients needed mechanical ventilation to maintain adequate gas exchange. This is probably associated with the use of the fairly high dose of fentanyl, which is required to ensure adequate analgesia. With equal fresh gas streams, the consumption of desflurane doubled that of sevoflurane. The postanesthetic awakening period turned out to be equal in both groups. The length of awakening unit stay after anesthesia with desflurane proved to be shorter than after that with sevoflurane. Conclusion. Desflurane-based anesthesia is attractive when it is important to reduce the length of postoperative unit stay as far as possible. If 10–12 more minutes are uncritical to do this, sevoflurance-based anesthesia is preferable. Цель исследования: изучить особенности периодов поддержания и пробуждения при анестезии на основе севофлурана и десфлурана в амбулаторной хирургии. Материалы и методы. Анализ течения интра- и ближайшего послеоперационного периодов проведён у 125 пациентов. В зависимости от варианта анестезии пациентов в случайном порядке (метод конвертов) включали в одну из двух исследуемых групп: 1-ю группу - анестезия на основе десфлурана (n = 62); 2-ю - анестезия на основе севофлурана (n = 63). Результаты. Во время выполнения оперативного вмешательства все пациенты 1-й группы нуждались в искусственной вентиляции лёгких для поддержания адекватного газообмена. Вероятно, это связано с применением достаточно высокой дозы фентанила, необходимой для обеспечения полноценной анальгезии. При одинаковых потоках «свежего» газа расход десфлурана был более чем в 2 раза выше, чем севофлурана. Продолжительность периода посленаркозного пробуждения в обеих группах оказалась одинаковой. Время пребывания в палате пробуждения при использовании десфлурана оказалось меньше, чем севофлурана. Заключение. Анестезия на основе десфлурана привлекательна тогда, когда важно максимально сократить время пребывания пациентов в послеоперационной палате. Если для организации работы лишние 10-12 мин некритичны, лучше использовать анестезию на основе севофлурана

Хельсинкская декларация по безопасности пациентов при оказании анестезиологической помощи – российский опыт: анкетное исследование

The objective: to determine the quality of knowledges about the Helsinki Declaration on Patient Safety among Russian anesthesiologists and intensivists and how widely its vision and standards have been adopted in clinical practice.Subjects and Methods. The study design involved the creation of 44-item online and offline questionnaire. The questions were divided into three blocks: personal information, data on hospitals where respondents work, and questions about implementation of the Helsinki protocol in their practice. Some of the questions required open answers. Persons with higher medical education who have completed residency and/or internship in anesthesiology and resuscitation and are working in this field in the Russian Federation were invited to participate in the survey.Results. 140 (21.5%) respondents answered all the question of the questionnaire. Of those surveyed, 76.4% were familiar with the Helsinki Declaration on Patient Safety, but only 17.1% felt they had sufficient knowledge of the concept. 43.6% of the respondents apply the Helsinki Declaration on Patient Safety to their clinical practice, while 49.3% of the respondents had difficulty answering whether they follow the Declaration in their work or not. The study showed a satisfactory level of compliance with mandatory standards for monitoring in the perioperative period but all the EBA-recommended standards are applied in only 23% of the hospitals. 26.4% of the respondents use the Safe Surgery Checklist prepared by the World Health Organization. 58.6% of the respondents use the reporting/notification system for adverse events or critical conditions in the perioperative period.Conclusion. The survey has shown that many of the surveyed anesthesiologists and intensivists have good knowledge of the Helsinki Declaration on Patient Safety and successfully apply it to their clinical practice but some doctors do it unconsciously, not understanding what standards they follow. Organization of additional educational programs could help physicians to improve their knowledge and raise their awareness in order to provide safer patient care. We also suggest introduction of unified checklists and national reporting systems for adverse events or critical conditions in the perioperative period.Цель исследования: определить распространенность знаний о принципах Хельсинкской декларации среди российских анестезиологов-реаниматологов и оценить, насколько эти принципы соблюдаются в клинической практике.Материалы и методы. Дизайн исследования ‒ создание анкеты (44 вопроса) в онлайн- и офлайн-форматах. Анкета включала три блока: личные данные, характеристика места работы респондента, применение декларации в клинической практике респондента. На часть вопросов можно было дать открытые ответы. К участию в анкетировании приглашались лица с высшим медицинским образованием, закончившие ординатуру и/или интернатуру по специальности «анестезиология и реаниматология» и работающие по ней в Российской Федерации.Результаты. На вопросы полностью ответили 140 (21,5%) респондентов. С Хельсинкской декларацией по безопасности пациентов было знакомо 76,4% опрошенных, но из них лишь 17,1% посчитали, что у них достаточно знаний об этой концепции. На рабочем месте положения Хельсинкской декларации по безопасности пациентов соблюдают 43,6% опрошенных, а 49,3% затруднились ответить, следуют ли они в своей работе рекомендациям декларации. Отмечен удовлетворительный уровень соблюдения обязательных стандартов мониторинга в периоперационном периоде, однако все без исключения стандарты минимального мониторинга состояния пациента, рекомендованные EBA, применяются лишь в 23% учреждениях, 26,4% респондентов имплементировали в свою практику «чек-лист безопасной хирургии» (Safe Surgery Checklist), подготовленный Всемирной организацией здравоохранения. Систему отчетности/уведомления о развитии нежелательных явлений или критических состояний в периоперационном периоде используют 58,6% респондентов.Вывод: многие из опрошенных анестезиологов-реаниматологов знают о Хельсинкской декларации по безопасности пациентов и успешно применяют ее положения в своей клинической практике, однако часть врачей делают это неосознанно, не понимая, каким стандартам они следуют. Организация и проведение дополнительных образовательных программ могут улучшить знания и осознанность врачей на пути к более безопасному лечению пациентов. Представляется актуальным введение единых чек-листов и создание национальных систем отчетности о развитии нежелательных явлений или критических состояний в периоперационном периоде

ВОЗМОЖНОСТИ МАГНИТНО-РЕЗОНАНСНОЙ ТОМОГРАФИИ В ДИАГНОСТИКЕ КОМПРЕССИОННО-ИШЕМИЧЕСКИХ НЕВРОПАТИЙ РУК У ПАЦИЕНТОВ С ГИПОТИРЕОЗОМ

Symptoms of neuromuscular dysfunction are quite common in patients with hypothyroidism. Structural changes of myelin and dysfunction of oligodendroglial processes in axons have pathogenetic significance in patients with neuropathies against the background of hypothyroidism. However, the etiopathogenesis of the development of neuropathies in hypothyroidism is not fully understood. Magnetic resonance imaging (MRI) is a modern imaging method that now provides an image of nerve trunks with a quality sufficient to assess their condition. The main task of MRI is to assess the difficult and atypical cases of nerve compression. We examined 26 patients diagnosed with hypothyroidism, including 8 patients with degenerative-dystrophic diseases of the spine, 1 patient — an anomaly of nerves and muscles, 2 patients were found to have the consequences of injuries, 1 patient was diagnosed with De-Kervin disease, and 14 patients with comorbidity, leading to nerve compression, was not found. The aim of the study was to assess the diagnostic capabilities of magnetic resonance imaging for compression-ischemic neuropathies of the hands in patients with hypothyroidism. Neurological examination and data from stimulation electroneuromyography allows you to accurately determine the area of investigation for MRI. The article shows the diagnostic capabilities of MRI, as well as its place in the diagnostic algorithm of compression-ischemic neuropathies of the hands in patients with hypothyroidism.Симптомы нервно-мышечных дисфункций достаточно часто встречаются у больных гипотиреозом. Структурные изменения миелина и дисфункция олигодендроглиальных процессов в аксонах имеют патогенетическое значение у пациентов с невропатиями на фоне гипотиреоза. Однако этиопатогенез развития невропатий при гипотиреозе изучен не до конца. Магнитно-резонансная томография (МРТ) — современный метод визуализации, позволяющий получить изображение стволов нервов с качеством, достаточным для оценки их состояния. Основная задача МРТ заключается в визуализации нервного ствола и оценке трудных и атипичных случаев компрессии нерва. Целью исследования была оценка диагностических возможностей МРТ при компрессионно-ишемических невропатиях рук у пациентов с гипотиреозом. Обследованы 26 пациентов с диагнозом «гипотиреоз», из них 8 пациентов с дегенеративно-дистрофическими заболеваниями позвоночника, у одного пациента была выявлена аномалия нервов и мышц, у 2 пациентов — последствия травм, у одного пациента — болезнь Де-Кервена, у 14 пациентов сопутствующей патологии, приводящей к компрессии нервов, не обнаружено. Неврологическое обследование и данные стимуляционной электронейромиографии (ЭНМГ) позволяют точно определить зону исследования для МРТ. Вместе с тем исследования, посвященные изучению возможностей МРТ в диагностике периферических нейропатий, имеют единичный характер. В статье показаны диагностические возможности МРТ, а также ее место в диагностическом алгоритме компрессионно-ишемических невропатий рук у пациентов с гипотиреозом

Инфузионно-трансфузионная терапия и коррекция водно-электролитных нарушений при симультанной трансплантации фрагмента печени и ретрансплантации почки (клинический случай)

A clinical case of simultaneous surgery in the volume of transplantation of the left lateral sector of the liver and kidney retransplantation from one  living related donor to a 10-year-old girl with cirrhosis of the liver and after transplantectomy of the donor kidney is presented. The child born in  2013 was transferred to program hemodialysis in 2015 as a result of the development of end-stage chronic kidney disease (CKD) in the outcome of  congenital kidney dysplasia. In October 2022, renal replacement therapy was started as a result of a relapse of end-stage CKD. In January 2023, she  suffered purulent cystitis. 02.24.2023 – transplantectomy. 05.05.2023, simultaneous transplantation of the left lateral sector of the liver and kidney  allotransplantation from a living related donor were performed. Anesthesiologists faced a serious problem in the form of the selection of adequate  infusion therapy, taking into account the combination of two surgical interventions that radically differ in the tactics of anesthesiological support,  as well as the correction of water – electrolyte disorders in the complete absence of diuresis throughout the fifteen-hour surgical intervention Представлен клинический случай симультанной операции в объеме трансплантации левого латерального сектора печени и ретрансплантации  почки от одного живого родственного донора девочке 10 лет с циррозом печени и после трансплантатэктомии донорской почки. Ребенок  2013 г. рождения в 2015 г. переведен на программный гемодиализ в результате развития терминальной стадии хронической болезни почек  (ХБП) в исходе врожденной дисплазии почек. В октябре 2022 г. начата заместительная почечная терапия в результате рецидива терминальной стадии ХБП. В январе 2023 г. перенесла гнойный цистит. 24.02.2023 г. – трансплантатэктомия. 05.05.2023 г. выполнена симультанная  трансплантация левого латерального сектора печени и аллотрансплантация почки от живого родственного донора. Перед анестезиологами встала серьезнейшая проблема в виде подбора адекватной инфузионной терапии с учетом сочетания 2 оперативных вмешательств, кардинально отличающихся по тактике анестезиологического обеспечения, а также коррекция водно-электролитных  нарушений при полном отсутствии диуреза на протяжении всего пятнадцатичасового оперативного вмешательства

Empagliflozin in patients hospitalized for acute decompensated heart failure: an expert resolution on the discussion of the EMPULSE trial

An online expert meeting held on November 17, 2021 reviewed the results of the randomized, double-blind, multinational, parallel-group EMPULSE trial, evaluating the clinical benefit and safety of the sodium-glucose co-transporter-2 inhibitor (SGLT2i) empagliflozin compared with placebo in patients hospitalized with acute decompensated heart failure (ADHF). Patients were included in the study regardless of ejection fraction (EF) and the presence of diabetes and randomized during hospitalization after stabilization. In addition, the EMPULSE trial used a composite result analyzed using a stratified benefit ratio — Win Ratio analysis. There is evidence of clinical benefit of empagliflozin in hospitalized patients with preserved and reduced LVEF, as well as in patients with newly diagnosed ADHF or with acute decompensation of chronic heart failure (CHF) compared with placebo, regardless of type 2 diabetes presence. The importance of the favorable results of the EMPULSE trial and its significance for clinical practice, which implies the early administration of empagliflozin for inpatients, is noted. A number of proposals have been adopted to accelerate the introduction of empagliflozin into clinical practice for patients with ADHF