ЗНАЧЕННЯ ІНТРА- ТА ПІСЛЯОПЕРАЦІЙНИХ УСКЛАДНЕНЬ У ПРОГНОЗУВАННІ ВИХОДУ ХІРУРГІЧНОГО ЛІКУВАННЯ ПРОЛІФЕРАТИВНОЇ ДІАБЕТИЧНОЇ РЕТИНОПАТІЇ

The article describes  the results  in detection some factors that may predict visual outcome after vitrectomy for proliferative diabetic retinopathyВ статье представлены результаты определения прогностической ценности влияния факторов риска (интраоперационных и послеоперационных осложнений) на результат хирургического лечения пациентов с диабетической пролиферативной ретинопатией.У статті представлені результати визначення прогностичної цінності впливу інтраопераційних та післяопераційних ускладнень як факторів ризику на результат хірургічного втручання у хворих з проліферативною  діабетичною ретинопатією

Metabolomic profiles as a new understanding of disease processes

Aim. This review will demonstrate possibilities of using metabolomic profiling to identify biomarkers of various internal organs diseases.Key points. A new diagnostic direction is associated with high-sensitive spectral analysis of biomarker molecules. This review will discuss some of the latest advances with an emphasis on the use of metabolomics to identify major metabolic changes in various diseases. The possibility of finding diagnostic markers in diseases of the gastrointestinal tract, respiratory and cardiovascular systems, in oncology, endocrinology, neurology are discussed. These results define new potential therapeutic strategies, making metabolomics useful for a wide range of biomedical and pharmaceutical research.Conclusion. Metabolomic profile changes in different types of diseases will help to improve understanding of the pathogenesis. New therapeutic approaches may be developed. They will take into account individual characteristics of the patient, identified by using current molecular technologies. The results of metabolomic studies can be used to monitor treatment outcomes

Dexamethasone in Treatment of Comorbid SARS-CoV-2 Patients Aged over 50 Years with Lung Injury over 50 %

Aim. An efficacy assessment of steroid therapy in SARS-CoV-2 patients aged over 50 years with lung damage over 50 % (grade 3–4).Materials and methods. A retrospective study of 158 SARS-CoV-2 patients hospitalised in April—June 2020 was conducted under the inclusion criteria: age over 50 years, chest computed tomography (CT) for COVID-19-asso-ciated pneumonia, C-reactive protein (CRP) >50 mg/L, anticoagulant therapy, no contraindications to steroids, no biologic therapy. Cohort 1 patients (n = 96) received dexamethasone 4–12 mg/day, cohort 2 (n = 62) — a standard non-dexamethasone therapy.Results. Dexamethasone treatment associated with a significant alleviation of COVID-19-associated pneumonia in CT score (p = 0.001), reduced fibrinogen (p = 0.001), a trend to CRP reduction by day 8–10 and lower demand for oxygen therapy, including ventilatory support (p = 0.001). Mortality rate was 19.8 and 75.8 % in cohorts 1 and 2, respectively (p = 0.001).Conclusion. Dexamethasone therapy 4–12 mg/day in SARS-CoV-2 patients aged 50+ years with grade 3–4 CT changes receiving LMWH from start of hospitalisation significantly improved CT scores and reduced mortality

Gut Microbiota and its Metabolites in Pathogenesis of NAFLD

Aim: to provide information on the results of recent scientific research in the field of non-alcoholic fatty liver disease (NAFLD) metabolomic profiling.Key points. Metabolites of microbial origin are important biological molecules involved in many specific reactions of the human body. This literature review presents the results of recent studies in the field of metabolomics in patients with NAFLD. A more detailed understanding of the role of individual metabolites or their combinations in the NAFLD pathogenesis will allow us to determine the vector of further diagnostic and therapeutic approaches for this nosology. The research results of the probiotics effect on the levels of certain metabolites are currently being discussed.Conclusion. New research data in the field of studying the human metabolomic profile are presented. The results allow us to summarize the effects of microbial agents and their metabolites in the formation of changes in the liver parenchyma in the context of NAFLD. Changes in the level of endogenous ethanol, secondary bile acids, aromatic amino acids, branched chain amino acids, etc. have been described. Correlation between metabolites and certain bacterial strains has been established. A correlation between the ratio of bacteria types and clinical/laboratory parameters was noted in patients taking prebiotics

Digestive Disease Mortality Dynamics During New Coronavirus Infection Pandemic in Different Subjects of Russian Federation

Aim. An analysis of digestive disease mortality dynamics in different subjects of the Russian Federation in course of the new coronavirus infection pandemic.Key points. In most subjects of the Russian Federation, the first half of 2021 enduring the COVID-19 pandemic has witnessed a higher overall mortality from digestive diseases and from peptic ulcer, liver and pancreatic illnesses compared to the same period in 2020. This situation may have roots in both the adverse impact of coronavirus infection on pre-existing digestive diseases and shortages in providing specialty medical aid to gastroenterological patients during the pandemic. Improved outpatient care and remote counselling, as well as successful educational measures, may reduce gastroenterological disease-associated mortality.Conclusion. Most regions of Russia have registered a growing mortality from digestive diseases at the new coronavirus infection pandemic due to the SARS-CoV-2 adverse impact on illness progression, as well as imposed difficulties in providing specialty medical aid

New Coronavirus Infection (COVID-19) and Digestive System

Aim. The study reviews current evidence on digestive system lesions provoked by the new COVID-19 coronavirus infection.Key points. Alongside the destructive impact on respiratory system, COVID-19 manifests itself in gastrointestinal symptoms (nausea, vomiting, diarrhoea) that may precede respiratory signs and prevail in the clinical picture of infection. Patients with chronic inflammatory bowel diseases receiving immunosuppressive therapy are at elevated risk of severe COVID-19 progression. The new coronavirus infection may induce liver damage with increased transaminase activity.Conclusion. Association of digestive system lesions with COVID-19 remains understudied and requires further research

Modern Approaches to the Diagnosis and treatment of <i>Clostridioides difficile (C. difficile)</i>-associated Disease in Adults (literature Review and Expert Council Resolution)

Aim: to review the modern approaches to the diagnosis and treatment of C. difficile-associated disease in adults and present the resolution of the Expert Council held on March 25, 2023 in Moscow.General provisions. C. difficile is the most important nosocomial pathogen which spores are also commonly found in the environment. Microbiota impairment, primarily due to the use of antibacterial drugs, is a key stage in the development of C. difficile-associated disease. A search for an infection should be carried out only in patients with diarrhea, and it is advisable to use at least 2 laboratory methods. The drug of choice for first-line treatment is vancomycin. If drug treatment is ineffective or the patient has recurrent clostridial infection, fecal microbiota transplantation should be considered. The probiotic strain Saccharomyces boulardii CNCM I-745 has a direct inhibitory effect on C. difficile toxin A, promotes normalization of the intestinal microbiota composition, and decreases the inflammatory reaction in colonic mucosa colonized with a toxigenic strain of C. difficile.Conclusions. Addition of the probiotic strain Saccharomyces boulardii CNCM I-745 to antibacterial therapy promotes both primary and secondary prevention of C. difficile-associated disease

Practical Recommendation of the Scientific Сommunity for Human Microbiome Research (CHMR) and the Russian Gastroenterological Association (RGA) on Small Intestinal Bacterial Overgrowth in Adults

Aim. To optimize the choice of treatment strategies by physicians and gastroenterologists to improve treatment and prevention of small intestinal bacterial overgrowth (SIBO) in adults.Key points. SIBO is a condition characterized by an increased amount and/or abnormal composition of the microbiota in the small intestine. Clinically, the syndrome is manifested by nonspecific gastroenterological complaints and the development of malabsorption syndrome. Most often, SIBO is associated with various chronic non- infectious diseases (both diseases of the gastrointestinal tract, and the cardiovascular system and the neuromuscular apparatus) and can affect the severity of their symptoms. Specific methods for diagnosing SIBO are the culture method and breath tests. The main approaches to the treatment of SIBO include the elimination of the underlying cause of its occurrence, the use of antibacterial drugs and adherence to dietary recommendations (elemental diet).Conclusion. Small intestinal bacterial overgrowth is common in patients with various diseases, but has non-specific manifestations, so proper diagnosis of this condition is required. SIBO therapy involves prescription of antibacterial agents, the most studied of which is the non-absorbable antibiotic rifaximin-α

Diagnosis and Treatment of Irritable Bowel Syndrome: Clinical Recommendations of the Russian Gastroenterological Association and Association of Coloproctologists of Russia

Aim. Current clinical recommendations accentuate current methods for the diagnosis and treatment of irritable bowel syndrome (IBS).Key points. IBS is a functional bowel disorder manifested with recurrent, at least weekly, abdominal pain with the following attributes (any two leastwise): link to defecation, its frequency or stool shape. The symptoms are expected to persist for at minimum three months in a total six-month follow-up. Similar to other functional gastrointestinal (GI) disorders, IBS can be diagnosed basing on the patient symptoms compliance with Rome IV criteria, provided the absence of potentially symptom-causative organic GI diseases. Due to challenging differential diagnosis, IBS can be appropriately established per exclusionem, with pre-examination as follows: general and biochemical blood tests; tissue transglutaminase IgA/IgG antibody tests; thyroid hormones test; faecal occult blood test; hydrogen glucose/ lactulose breath test for bacterial overgrowth; stool test for enteric bacterial pathogens and Clostridium difficile A/B toxins; stool calprotectin test; abdominal ultrasound; OGDS, with biopsy as appropriate; colonoscopy with biopsy. The IBS sequence is typically wavelike, with alternating remissions and exacerbations often triggered by psychoemotional stress. Treatment of IBS patients includes dietary and lifestyle adjustments, various-class drug agents prescription and psychotherapeutic measures.Conclusion. Adherence to clinical recommendations can facilitate timely diagnosis and improve medical aid quality in patients with different clinical IBS variants