Detection of macro-thyrotropinaemia in patients with Hashimotos thyroiditis and subclinical hypothyroidism

The level of thyroid stimulating hormone is one of the diagnostic indicators of thyroid function. In subclinical hypothyroidism, its concentration in the blood serum increases, while the level of thyroid hormones remains normal. One of the reasons for this is the phenomenon of macrotyrotropinemia, in which the macro isoforms of thyrotropin (a complex of thyrotropic hormone with immunoglobulin) are present in the blood. It is assumed that the biological activity of macrotyrotropin is low, and may accumulate in the circulation, causing a falsely elevated level of thyroid-stimulating hormone in serum. The aim of this study is to identify the nature and prevalence of the macrothyrotropinemia phenomenon among patients with subclinical hypothyroidism in presence of autoimmune thyroiditis and a group of healthy donors. Materials and methods: Fifty serum samples of venous blood served as the material for the study: 30 patients with subclinical hypothyroidism in presence of autoimmune thyroiditis; 10, with manifesting hypothyroidism, 10 conditionally healthy donors without thyroid gland pathology (control group). The group was derived from results of the clinical laboratory at the Clinical Hospital at the Kazan station railway. Patients’ blood serum was screened for the presence of macrotrorotropin by polyethylene glycol precipitation method, followed by analysis by gel filtration chromatography. Results of this study were as follows: screening of blood sera was performed by gel filtration and affinity chromatography. Polyethylene glycol was shown to precipitate 50 to 100% serum thyrotropin, of which true macrotrothropin makes 56-98%. In the patients with subclinical hypothyroidism with a thyroid-stimulating hormone level of more than 10 pIU/ml, a trend towards an increase in the level of macrothyrotrophinaemia has been shown. The content of macrotyrotropin complex in patients with subclinical hypothyroidism, in whom the level of antibodies to thyroperoxidase is > 500 U/L, is significantly higher if compared to the patients with manifesting hypothyroidism. Elevated levels of antibodies to thyroperoxidase can lead to the generation of macrotyropin. Our findings have shown that the phenomenon of macrothyrotropinemia is quite common in patients with subclinical and manifesting hypothyroidism with Hashimoto thyroiditis (53.3%) and in control group (25%). Macrotyrotropin complex probably consists of thyrotropin and IgG. Patients with a thyroid-stimulating hormone level of > 10 pIU/ml are candidates for screening for the presence of the macrotyrotropin complex.The activity of the autoimmune process may correlate with the phenomenon of macrothyrotropinemia. The results can be used to develop an additional tool when choosing therapy in clinical practice

The problem of abailability of unregistered medicines in russia for patients with severe diseases

The article analyzes the legal framework governing the admission of medicines originating from foreign countries that are included in the list of vital and essential medicines. The information collected by the author about the most significant problems of legal regulation of obtaining imported drugs is studied and systematized. A number of proposals are being made to improve Russian legislation aimed at providing quality and affordable services for people in need.В статье анализируется нормативно-правовая база, регулирующая допуск происходящих из иностранных государств лекарственных препаратов, включенных в перечень жизненно необходимых и важнейших лекарственных препаратов. Изучается и систематизируется собранная автором информация о наиболее значимых проблемах правого регулирования получения импортных препаратов. Делается ряд предложений по совершенствованиюроссийского законодательства, направленных на обеспечение качественных и доступных услуг для нуждающихся граждан

Thirteen-Year Follow-Up of a Patient with Liver Cirrhosis Resulting from the Overlap Syndrome of Autoimmune Hepatitis and Primary Biliary Cholangitis: Severe COVID-19 and Liver Transplantation

Aim: to present the difficulties of long-term management of a patient with liver cirrhosis in the outcome of overlap syndrome (autoimmune hepatitis and primary biliary cholangitis) who suffered from severe COVID-19 infection.Key points. The diagnosis of liver cirrhosis as an outcome of overlap syndrome (autoimmune hepatitis and primary biliary cholangitis) was established at the patient’s age of 33 years. At the age of 40, the patient became pregnant for the first time, the pregnancy proceeded well, and a cesarean section was performed at 36 weeks. At the age of 45, the patient suffered a severe new coronavirus infection, followed by decompensation of liver cirrhosis, which required liver transplantation 4 months after COVID-19, followed by a favorable postoperative course.Conclusion. This clinical case demonstrates the successful onset and outcome of pregnancy in a patient with liver cirrhosis in the outcome of overlap syndrome (autoimmune hepatitis and primary biliary cholangitis). The pronounced activity of the disease after severe new coronavirus infection required liver transplantation with successful outcome

Study of the Thermochemical Effect on the Transport and Structural Characteristics of Heterogeneous Ion-Exchange Membranes by Combining the Cell Model and the Fine-Porous Membrane Model

For the first time, based on the joint application of the fine-porous and cell models, a theoretical analysis of the changing transport and structural characteristics of heterogeneous polymeric ion-exchange membranes (IEMs) MK-40, MA-40, and MA-41 after exposure to elevated temperatures in water and aggressive media (H2SO4 and NaOH solutions), as well as after long-term processing in electrodialyzers of various types, was carried out. The studied membranes are composites of ion-exchange polymers with polyethylene and nylon reinforcing mesh. The external influences provoke the aging of IEMs and the deterioration of their characteristics. The transport properties of IEMs are quantitatively described using five physicochemical parameters: counterion diffusion and equilibrium distribution coefficients in the membrane, characteristic exchange capacity, which depends on the microporosity of ion-exchanger particles, and macroscopic porosity at a known exchange capacity of IEMs. Calculations of the physicochemical parameters of the membranes were performed according to a specially developed fitting technique using the experimental concentration dependences of integral diffusion permeability and specific electrical conductivity, and their model analogs. This made it possible to identify and evaluate changes in the membrane micro- and macrostructure and examine the process of artificial aging of the IEM polymer material due to the abovementioned external impacts