Vol 23, No 12 (2021)

Obesity and type 2 diabetes mellitus (T2D) are two non-infectious pandemics of the XXI century. Despite a large number of studies devoted to the development of obesity and T2D, it seems complicated to overcome the ongoing growth in the number of cases. In these situations it is necessary to investigate new approaches for the prevention and treatment of such diseases. One of these approaches is to study the role of gut microbiota in the disturbance of carbohydrate and lipid metabolism. This manuscript describes the role of the microbiota in obesity and T2D. The aim of the review was to describe various approaches to change the composition of the gut microbiota and to determine its impact on metabolic risks. To assess the relationship between T2D development and changes of microbiota composition we considered a number of studies devoted to the consequence of these pathophysiologic mechanisms in various situations: the effect of drug treatment, bariatric surgery and microbiota transplantation. Possible metabolically protective gut microbiota composition is discussed.

Background. The relationships between renin-angiotensin-aldosterone system (RAAS) and elevated parathyroid hormone levels in primary hyperparathyroidism (PHPT) is being actively discussed. But the way how parathyroid hormone interacts with renin and aldosterone currently is not clear.

Materials and methods. Forty patients aged 18 to 70 years with a confirmed diagnosis of PHPT were involved in the study. All patients were tested for the main parameters of phosphorus-calcium metabolism and the RAAS parameters (plasma renin, plasma aldosterone) before and 2 weeks after parathyroidectomy.

Results. Sixty percent of patients had any cardiovascular disease (CVD) and hypertension was the most common. Patients CVD in comparison with patients without CVD were older (61 and 41 years, respectively; p<0.001), had a higher body mass index (28.9 and 21.9 kg/m², respectively; p<0.001) and had a lower aldosterone-to-renin ratio – ARR (1.78 and 5.42, respectively; p=0.030). Patients with hypertension were older than patients with normal blood pressure (63 and 41 years, respectively; p<0.001), had a higher body mass index (28.1 and 23.5 kg/m², respectively; p=0.005), a lower ARR (1.46 and 5.82, respectively; p=0.001), as well higher levels of plasma renin (109.2 and 20.3 pg/ml, respectively; p=0.007) and serum total calcium (2.84 and 2.71 mmol/l, respectively; p=0.041). Correlation analysis showed that in patients with PHPT and CVD, the concentration of aldosterone is associated with the level of 24-hour urinary calcium (r=0.829, p=0.042), and in patients with symptomatic PHPT and CVD, the level of aldosterone correlated with the level of ionized calcium (r=-0.812, p=0.05). We found no significant differences between the levels of renin, aldosterone and ARR before and 2 weeks after parathyroidectomy. However, in the postoperative period, there were no differences in the levels of renin and ARR among patients with hypertension and without hypertension.

Conclusion. In our study we found that the levels of plasma renin and serum total calcium were higher in patients with PHPT and hypertension compared to patients with normal blood pressure. Also, we found the associations between plasma aldosterone and levels of ionized calcium and 24-hour urinary calcium. But the relationships between RAAS parameters and parameters of phosphorus-calcium metabolism need further investigations.

Aim. To assess the frequency of contrast-induced acute kidney injury (CI-AKI) in patients with cardiovascular diseases (CVD) undergoing computed tomography (CT) with intravenous contrast media.

Materials and methods. In prospective observational study (ClinicalTrials.gov ID NCT04666389) were included 51 patients with CVD undergoing CT with intravenous contrast media administration. The primary endpoint was CI-AKI according to KDIGO criteria [the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 48–72 hours after administration of contrast media]. There were 51% of women included in the study. The average age was 61.74±1.5. The most frequent cardiovascular disease was hypertension in both men and women – 52 and 39% respectively.

Results. CI-AKI was diagnosed in 2 (3.92%) patients. At the same time, it was not possible to establish statistically significant relationship (p<0.05) between risk factors and the development of CI-AKI.

Conclusion. Cardiovascular diseases may increase the risk of CI-AKI after CT with intravenous contrast media administration. Therefore, it is recommended to evaluate the serum creatinine concentration in such patients.

There are a lot of clinical variants of hepatic impairment ranging from asymptomatic increase in transaminases to acute liver failure and fulminant hepatitis. Hepatic impairment is a polietiologic syndrome. According to the epidemiological study conducted in the United States (1998–2008), the main causes of hepatic impairment were paracetamol overdose (46%), idiopathic liver dysfunction (14%), other drugs (excluding paracetamol, 11%), viral hepatitis B (7%), other infectious and non-infectious diseases with liver damage (except for viral hepatitis) – 7%, autoimmune hepatitis (5%), ischemic hepatitis (syn. hypoxic hepatitis, liver infarction) – 4%, viral hepatitis A (3%) and Wilson's disease (2%). Hepatic impairment have a direct impact on the pharmacokinetics and pharmacodynamics of drugs decreasing clearance, elimination and excretion of drugs. Also Transjugular intrahepatic porto-systemic shunts, which are often used to treat portal hypertension in patients with liver cirrhosis, can significantly reduce the presystemic elimination of drugs, thereby increasing their absorption. Moreover, in patients with liver cirrhosis, concomitant renal dysfunction also requires an adjustment of the dose of drugs. Correction of pharmacotherapy in accordance to pharmacokinetic and pharmacodynamic changes of drugs ingested by patients with impaired liver function will improve the quality of medical care and reduce the risks of adverse drug reactions.

Middle ear cholesteatoma (MEC) is a common problem of modern otology. The European Academy of Otology and Neurootology in cooperation with the Japanese Otological Society (EAONO/JOS) published consensus recommendations on the definition, classification and stages of MEC in 2017. In 2018, the classification of middle ear surgery was presented under the auspices of the International Otology Outcome Group. The leading problem of MEC surgery remains the high recurrence rate, which ranges from 5 to 32% depending on the type of surgical intervention. The main purpose of this article is to describe the new EAONO/JOS classification of MEC and SAMEO-ATO middle ear surgical interventions with an analysis of their possible clinical significance in determining the risk of cholesteatoma recurrence as well as the prognosis for hearing recovery after surgery.

Diffuse alopecia (DA) is a disease characterized by a diffuse hair loss associated with alterations in physiological hair cycle due to an exposure of hair follicles to various endogenous and exogenous factors. The disease is mainly caused by alterations in the cyclicity of hair follicle phases – anagen, telogen and catagen. Pathogenetic therapy for DA is based on the initiation and lengthening of the anagen phase, in particular, via inhibition of catagen. Given a high prevalence of DA following a new coronavirus infection (COVID-19), the search for an effective medicine for the SARS-CoV-2 virus-associated DA is extremely important. The use of drugs derived from natural products can have a beneficial effect on the disease following COVID-19. The study was aimed to assess the efficacy of the combination of Selencin (homeopathic drug) and Selencin Peptide Active (peptide lotion) for the treatment of DA associated with prior coronavirus infection (COVID-19). A total of 34 patients with a confirmed diagnosis of telogen/anagen DA, who noted the relationship between DA and a new coronavirus infection, were treated with both systemic (pills) and topical (peptide lotion) Selencin for 2 months. The study showed a high efficacy of the treatment, i.e., a significant reduction in hair loss, as well as restoration of their structure and increase in volume. Also, after 2 and 4 months of treatment, there was a normalization of dermatoscopic picture of the scalp and an improvement in the special tests (PULL test). Thus, the use of the combined drug Selencin for SARS-CoV-2 virus-associated DA has a pronounced therapeutic effect. The drug can be used as the main treatment for this disease if it associated with COVID-19.

The discovery of antibiotics almost 100 years ago seemed to have forever solved the issue of treating infectious diseases for humanity. However, the avalanche-like growth in antibiotic resistance requires the search for alternative methods of treatment, one of which is treatment with herbal products created according to the phytoneering concept. It is a technology that combines the enormous potential of medicinal plants (phyto) with the knowledge and methodology of modern pharmaceutical research (engineering). The article presents 2 clinical cases of the use of the herbal product Canephron N for the prevention of cystitis and acute urolithiasis – common disorders in the practice of a urologist.

Background. Currently, there are large-scale changes in providing medical care in the oncology profile, that are reflected in the regulatory legal acts of the Ministry of Health of Russia, which will come into force in 2022 and will guide the classification of medical organizations providing services, as well as the features of diagnosing diseases, and standards for equipping hospitals, departments and specialized offices. At the same time, the issues of features of a procedure for providing medical care outside the territory of patients' insurance remain unresolved.

Aim. To identify issues and prospects of the new procedure for providing care in the "oncology" profile outside the territory of patients' insurance using the analysis of the legal regulation established by orders of the Ministry of Health of Russia that are coming into force, and law-enforcement practice.

Materials and methods. The analysis of the sources of legal regulation of the procedure for providing medical care to cancer patients, which are coming into force in the near future, was carried out. The analysis with the formal legal method allowed us to identify the essence, content, and legal consequences of the implementation of the norms governing the relations under discussion.

Conclusion. The analysis of the prospects for the implementation of the new regulatory legal acts allowed us to formulate a series of proposals. First, it is recommended to provide informing patients and their relatives about the procedure for getting medical services outside the territory of their insurance. Secondly, it is proposed to ensure that medical organizations of the constituent entities of the Russian Federation and their officials are prohibited from restricting the patient's right to choose a doctor and a medical organization, such as refusing to issue a referral or misinformation about not having patient's right to independently seek medical help from a medical organization in another region. Third, the authors consider the practice of limiting the provision of medical care in the "oncology" profile in special federal centers by compiling lists of such organizations to be unreasonable and inappropriate. We also propose to create a unified specialized hospital stoke for the treatment of oncological diseases in the constituent entities of the Russian Federation and to establish the volume of medical care in the "oncology" profile in the constituent entities of the Russian Federation on the basis of medical organizations which participate in territorial compulsory health insurance programs, given real resources and the needs of medical services.