[Correction of intestinal microbial composition disturbances as a potential link in complex therapy of patients with COVID-19].

The article reflects the potential for correcting intestinal microbiota disorders in the complex therapy of patients with COVID-19. It has been noted that the inclusion of dietary fiber in the diet contributes to protection against disruption of the integrity of the intestinal barrier and may limit bacterial translocation into the systemic circulation. The possibility of using psyllium (Mucofalk) is reflected, the action of which is realized both through its sorption, cytoprotective and anti-inflammatory properties in viral lesions of the gastrointestinal tract, and through stimulation of the own beneficial intestinal microbiota. The paper presents studies of the prospects for the use of probiotics, synbiotics in the complex therapy of patients with COVID-19. Detailed data are provided on the mechanisms of the positive effect of short-chain fatty acid preparations on reducing the severity of the disease in patients with COVID-19. It was noted that taking the drug Zacofalk leads to a significant increase in its own butyrate-producing microbiota (Faecalibacterium prausnitzii) and suppression of the growth of opportunistic flora with pro-inflammatory activity. The results of a recent study are presented showing that in patients with a mild course of COVID infection with respiratory and intestinal symptoms, the administration of Zakofalk for 30 days (3 tablets per day) led to significantly faster stool normalization (by day 7), persistent normalization of the frequency and consistency of stools by the 21st day and a significantly more pronounced regression of bloating and abdominal pain, as well as a decrease in the risk of developing post-infectious irritable bowel syndrome.

[Inflammatory diseases of the pancreas: what new do we know about the mechanisms of their development in the 21st century?]

Inflammatory diseases of the pancreas can range from acute to acute recurrent and chronic pancreatitis. With the improvement of laboratory diagnostics in the 21st century, the mechanisms of the pro-inflammatory and anti-inflammatory role of tight junctions, in particular the transmembrane proteins occludin, claudine and JAMs, cytoplasmic Zo-proteins, and adherens junctions, in particular -catenin, -catenin, E-cadherin, selectins and ICAMs in the pathogenesis of acute and chronic pancreatitis have become more clear. The study of genetic factors in the development of acute and chronic pancreatitis showed the role of mutations in the genes SPINK1 N34S, PRSS1, CEL-HYB in the progression of the disease.

[Pancreatic diseases and inflammatory bowel diseases: a random or regular combination?]

Pathology of the pancreas in inflammatory bowel disease (IBD) is more common than in the general population and includes a wide range of manifestations from asymptomatic to severe disorders. Acute pancreatitis, chronic pancreatitis, autoimmune pancreatitis, exocrine pancreatic insufficiency, increased pancreatic enzymes and structural duct anomalies are often associated with IBD. They can be either a manifestation of IBD itself or develop independently.

Role of intestinal microbiota in the formation of non-alcoholic fatty liver disease.

The article provides an overview of modern views on the role of intestinal microbiota in the formation of non-alcoholic fatty liver disease. The general questions of the pathogenesis of the syndrome of excessive bacterial growth in the intestine, the participation of opportunistic microflora, the deficit of representatives of normal microflora, changes in the species composition of bile acids in the pathogenesis of nonalcoholic fatty liver disease are considered.

Effectiveness of mebeverine in patients with post-cholecystectomy gastrointestinal spasm: results of prospective observational program "odyssey".

AIM: To assess the effectiveness of mebeverine 200 mg BID in patients with post-cholecystectomy gastrointestinal spasm not requiring surgical treatment. MATERIALS AND METHODS: 218 patients were included in 16 clinical centers in 14 cities in Russia. All patients had post-cholecystectomy gastrointestinal spasms, not requiring surgical treatment and received mebeverine (Duspatalin®) 200 mg BID. The observational assessment period lasted from the moment of their inclusion into the study up to 6 weeks post inlusion. The therapy results were evaluated using visual analog scales (GPA and 11-point numeric rating scale) by patient self-assessment of the dynamics of spasm/discomfort and other post-cholecystectomic gastrointestinal symptoms after 2 and 6 weeks of treatment. Gastrointestinal Quality of Life Index (GIQLI) was used to assess patient quality of life. RESULTS: All 218 patients completed the 2-week mebeverine treatment course, 101 of them finished the 6-week course ("prolonged population"). Significant positive changes in the relief of abdominal pain and dyspepsia were noted as well as normalization of stool frequency and consistency. A more marked change in values was observed during prolonged (up to 6 weeks) therapy. Both 2-week and 6-week mebeverine courses led to a normalization of patient quality of life. After 6 week therapy, an effect of mebeverine on the quality of life 91% of patients was observed comparable to cholecystectomy itself, speficially related to the quality of life subscore 'symptoms'. CONCLUSION: The results of our study demonstrate that mebeverine (Duspatalin®) therapy leads to an effective elimination of clinical symptoms associated with post-cholecystectomy GI-spasm disorders, like abdominal pain, symptoms of dyspepsia and stooldisorders. A more marked change in values was observed during prolonged (up to 6 weeks) therapy.

[Involvement of the hepatobiliary system and pancreas in obesity]. / Porazhenie organov gepatobiliarnoi sistemy i podzheludochnoi zhelezy pri ozhirenii.

The article provides an overview of current views on the involvement of the liver, gallbladder, and pancreas in patients with overweight and obesity. It considers the general issues of the pathogenesis of these conditions, their clinical features and diagnostic methods.

[Extragastric symptoms associated with Helicobacter pylori infection].

This review article highlights the modern views of manifestations associated with Hp infection. The data are presented about the negative impact of the infection on the state of the musculoskeletal system, the development of migraine, progression of diffuse liver disease and the risk of developing liver cancer. The paper also provides information on the possible effects of Helicobacter pylori infection on the formation of halitosis, tympanosclerosis, male reproductive health disorders, colorectal cancer, Alzheimer's and Parkinson's disease, pre-eclampsia during pregnancy, and idiopathic chronic urticaria. In addition, the negative relationship between Hp infection, bronchial asthma, and inflammatory bowel disease is considered.

[Nocturnal pulse oximetry indicators in the evaluation of obstructive sleep apnea syndrome in outpatients with concomitant diseases of the upper respiratory tract and overweight]. / Pokazateli nochnoi pul'soksimetrii v otsenke sindroma obstruktivnogo apnoé vo sne u ambulatornykh patsientov s soputstvuiushchei patologiei verkhnikh dykhatel'nykh putei i izbytochnoi massoi tela.

AIM: By using mathematical modeling, to evaluate the impact of upper respiratory tract diseases, retro- and micrognathia, and body mass index (BMI) on nocturnal pulse oximetry indicators (oxygen saturation level and oxygen desaturation index) in outpatients examined for suspected obstructive sleep apnea syndrome (OSAS). SUBJECTS AND METHODS: The study enrolled 260 subjects with a mean age of 47.8±12.0 years. All the examinees underwent outpatient pulse oximetry screening during nocturnal sleep because of suspected OSAS. Multislice spiral computed tomography was carried out to assess the paranasal sinuses and nasal septum. BMI was calculated. Variance factor analysis using an original programming application intended to create binary and ternary dispersion complexes was employed as a main mathematical tool. RESULTS: There were statistically significantly sets of risk factors for OSAS: nasal septum deviation + increased BMI + male gender = 68.66%; chronic allergic rhinitis + increased BMI + male gender = 63.09%; retromicrognathia + increased BMI + male ganger = 59.48%; and chronic tonsillitis + increased BMI + male gander = 60.88%. Higher BMI and male gender are a most statistically significant set of risk factors. CONCLUSION: Pulse oximetry screening during nocturnal sleep in snoring patients with suspected OSAS in combination with an assessment of age, sex, BMI, ENT comorbidity, retro- and micrognathia can predict the severity of the disease and serve as a basis for elaborating an OSAS screening program.

[THE CORRECTION OF THE LOCAL IMMUNE RESPONSE AT THE PATIENTS WITH HELICOBACTER PYLORI INFECTION].

INTRODUCTION: Helicobacter pylori infection is due to the high prevalence in population attracts the clinical interest of researchers in the whole World. It is well known that this microorganism not only resides in the mucosa of the gastrointestinal tract, but is also defined in the periodontal pocket of the oral cavity. THE AIM OF INVESTIGATION: to evaluate Helicobacter pylori diagnostics in the mouth and prove a method of relief of the inflammatory process by applying immunomodulator Imudon. RESULTS. On the basis of obtained results it was found that the inclusion of topical immunomodulator Imudon in the complex therapy of Helicobacter pylori-associated diseases leads to reduction of inflammatory potential through the decrease of the TNFα, IL-6 activity in saliva and to increase the protective properties of saliva as a result of increased levels of mucin, significantly reduces the frequency of relapses in the one year after therapy. CONCLUSION: It is practically important to determine the effectiveness of eradication therapy by the study of the contents of the tooth-gingival pocket for the detection of genetic material of Helicobacter pylori, as well as to include in the complex therapy of Helicobacter pylori-associated diseases of the immune modulator Imudon.

[The informative value of non-invasive liver fibrosis markers in patients with nonalcoholic fatty liver disease]. / Informativnost' neinvazivnykh markerov fibroza pecheni u patsientov s nealkogol'noi zhirovoi bolezn'yu pecheni.

AIM: To estimate the diagnostic and informative value of clinical and laboratory parameters in the development and progression of liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) to enhance efficiency of their treatment. SUBJECTS AND METHODS: An open-label case-control study included 77 patients with NAFLD. Clinical and laboratory examinations were done. To search for additional noninvasive fibrosis markers, the investigators studied the serum concentrations of insulin, leptin, adiponectin, matrix metalloproteinase-9 (MMP-9) and its inhibitors, such as tissue inhibitor of matrix metalloproteinases 1 (TIMP-1) and TIMP-2. All the patients underwent elastometry to assess the degree of liver fibrosis with the Metavir scale with the use of a Fibroscan machine. RESULTS: The serum levels of low-density lipoproteins, glucose, MMP-9, and leptin proved to be most informative in assessing the progression of the initial stages (1-2) of fibrosis, as were the increased liver size detected by physical examination, systolic blood pressure, carbohydrate metabolic disorders, alanine/aspartate aminotransferase levels, waist-to-hip ratio, TIMP-1, and TIMP-2 in evaluating the progression of Stage II fibrosis 2 to Stage 3. CONCLUSION: The clinical and laboratory parameters can serve as reliable noninvasive markers that reflect the progression of fibrotic changes in liver tissue.

[THE IMPACT OF METABOLIC SYNDROME ON THE STRUCTURAL AND FUNCTIONAL STATE OF THE LIVER PARENCHYMA].

The aim of study was to evaluate changes of biochemical, immunological parameters and the state of the liver parenchyma in patients with metabolic syndrome. The correlation analysis have shown significant connections between serum concentration of TIMP-1 and tryglicerid level (p = 0,04) and increase activity of GGTP (р = 0,0475). The activity of GGTP correlated with increase of lipoproteids of low density in serum (р = 0,034). The intensity of liver tissue changes on sonography in accordance with mathematical analysis was 2,31 ± 0,23 points.

MODERN VIEWS ON THE MECHANISMS OF FORMATION AND PROSPECTS OF THERAPY OF THE PAIN ABDOMINAL SYNDROME IN PATIENTS WITH CHRONIC PANCREATITIS.

Pain in chronic pancreatitis is one of the most mysterious and complex problems of modern gastroenterology. In a review article presents current information about intrapancreatic and central mechanisms of formation of pain in patients with chronic pancreatitis. Based on the pathogenetic mechanisms outlined prospects for the treatment of patients with chronic pancreatitis with pain syndrome.

[A RARE CLINICAL CASE OF CONGENITAL HYPOPROCONVERTINEMIA].

The paper reports a rare clinical case of congenital hypoproconvertinemia in an elderly woman repeatedly admitted to the Cardiological Department for the management of coronary heart disease and arterial hypertension. The detection of low prothrombin index in a series of analysis requiredfurther hematological examination that revealed the history of postoperative and postnatal hemorrhage along with markedly reduced factor VII level. These results were interpreted as evidence of a rare congenital pathology, hypoproconvertinemia.

[The development of functional gastrointestinal diseases: Genetic aspects]. / Geneticheskie aspekty formirovaniia funktsional'nykh zabolevanii zheludochno-kishechnogo trakta.

Motility disorders of the upper and lower gastrointestinal tract encompass a very wide range of structurally different diseases. Functional dyspepsia and irritable bowel syndrome (IBS) are the most common functional gastrointestinal disorders in clinical practice. In spite of the considerable prevalence of these functional diseases, the knowledge of their development mechanisms is very scarce. Recent investigations of the impact of the motor and sensory components of the pathogenesis of these diseases have demonstrated that the development of IBS is associated with serotonin transporter gene (5-HTTLPR) impairment and that the patients with IBS show the inadequate response to nonselective cannabinoid receptor agonists, which is caused by cannabinoid receptor gene (CNR1) polymorphism. Most investigations (mainly trials with small sample sizes) dealing with the identification of pharmacogenetic features have indicated that there is a preponderance of patients with intermediary metabolism among those with functional gastrointestinal diseases. However, larger investigations are necessary for a more exact understanding of this aspect.

[DYNAMIC OF CLINICAL, LABORATORY AND SONOGRAPHIC PARAMETERS AFTER SUCCESSFUL LITHOLITIC THERAPY AT PATIENTS WITH GALLSTONE DISEASE IN ASSOCIATION WITH METABOLIC SYNDROME].

UNLABELLED: The aim of study was to determine the leading clinical, immunological and sonographic pararneters, reflecting the efficiency of Ursodeoxycholic acid (UDCA) at the rate of 10 mg per 1 kg of body weight in the treatment of gallstone disease in patients with metabolic syndrome (MS). MATERIALS AND METHODS: An assessment of clinical, biochemical immunological and sonographic parameters in 54 patients with gallstone disease associated with the metabolic syndrome before and after the six-month treatment UDCA were made. RESULTS: In accordance with our results the significant predictors, reflecting successful litholitic therapy at patients with gallstone disease in association with metabolic syndrome are decrease the serum concentration of gamma-glutamyltranspeptidase (P = 0.003), matrix metalloproteinase-9 (P = 0.001), increase the serum concentration of tissue inhibitor of metalloproteinases-1 (P = 0.02), decrease the left liver lobe thickness (P = 0,003) and the thickness of gallbladder wall (P = 0.0002). CONCLUSION: The results of our study have shown that the therapy with ursodesoxycholic acid of patients with metabolic syndrome leads to decrease of factors of gallstone progression (elevated levels of gamma-glutamyltranspeptidase, matrix metalloproteinase-9 and increased thickness of the left lobe liver and gallbladder wall).

[Evaluation of prognostic factors for the development of cholelithiasis in patients with metabolic syndrome].

UNLABELLED: The aim of study to determine the leading clinical and immunological parameters, reflecting the high risk of development and progression of gallstone disease in patients with metabolic syndrome. MATERIALS AND METHODS: An assessment of clinical, biochemical and immunological parameters in 54 patients with gallstone disease associated with the metabolic syndrome and in comparison groups (31 with metabolic syndrome without gallstone disease and 29 with gallstone disease only) were made. For modeling the significant correlation and prediction of the effect of different combinations of factors on the risk of gallstone disease formation in patients with metabolic syndrome was used the multiple logistic regression analysis. RESULTS: In accordance with our results the main risk factors of gallstone formation in patients with metabolic syndrome are the age (P = 0.02), waist volume (P = 0.0002), the increase of serum concentration of GGTP (P = 0.00001), MMP-9 (P = 0.002) and TIMP-1 (P = 0.02). CONCLUSION: The results of our study have shown that in patients with metabolic syndrome was estimated the high risk of gallstone disease formation compared and the most significant factors of it formation are the patients age, waist volume and increase of serum concentration of GGTP, MMP-9 and TIMP-1.

[The clinical significance of matrix metalloproteases in heart and vascular pathology].

The matrix metalloproteases are the big family of endopeptidases that takes part in degradation of extracellular matrix. The investigation of clinical significance of matrix metalloproteases in heart and vascular pathology can organize the pathogenetic treatment of the patients with heart and vascular diseases.

[The participation of matrix metalloproteinases-9 and TIMP-1 in formation of atrial fibrillation paroxisms in patients with metabolic syndrome].

The aim of this study was to estimate the role of matrix metalloproteinases activity (MMP-9, TIMP-1) and gene polymorphism at the patients with metabolic syndrome in combination with paroxysmal form of atrial fibrillation. The 60 patients with metabolic syndrome in combination with paroxysmal form of atrial fibrillation were investigated with estimation of serum levels of MMP-9, TIMP-1 and mutation of genes of angiotenzinogen 1 Thr 174 Met, angiotenzinogen 2 Met 235 Thr and apolipoprorein C3 C3238 G. In patients with metabolic syndrome in combination with paroxysmal form of atrial fibrillation the significant increase synthesis of MMP-9 level can lead to increase of atrial fibrillation paroxysms because of increase synthesis of collagen tissue in myocard and vessel walls. Also the significant high incidence of angiotenzinogen 2 Met 235 Thr mutation was established.

[Combination of chronic obstructive lung disease and amyotrophic lateral sclerosis].

A case of chronic obstructive lung disease in combination with amyotrophic lateral sclerosis is described. It resulted in progressive respiratory insufficiency with the fatal outcome.

[The role of gastric pH and tissue hypoxia in formation of gastroduodenal zone mucose changes in heartsurgical patients].

The estimation of gastric contents pH and gastroduodenal zone mucous membrane condition based on the fibrogastroduodenoscopy data of40 patients who were examined and received proton pump inhibitors in the postoperative period after heart surgical intervention. It was estimated, that acidic peptic aggression and tissue hypoxia are important factors for occurrence of destructive gastroduodenal membrane changes in heart surgery patients. The differences of antisecretory activity of proton pump inhibitors are revealed, so it was useful to use analogous pH-test using in the intensive care unit. The preferences of original omeprazole for intravenous use with it antisecretory effect were marked in comparison with generic omeprazole: the stability of gastric contents pH more than 4,0 was in 100%, more than 6,0 was in 86% of the time for original drug and in 84% and in 27% for generic drug respectively. It is also demonstrated, that cardiotonic drugs using and prosthesis of cardiac valves are additional risk factors of gastroduodenal membrane destruction, independent of acidic aggression.