The gut microbiota regulates critical processes in host metabolism and physiology. Understanding the formation of relationships between the gut microbiome, liver, and other organs under physiological conditions, as well as under the influence of microbiota-damaging factors, provides important insights into the pathophysiology of not only liver diseases, but also the complex level of communication and the role of the microbiome in the gut-liver-brain, gut-liver-kidney, gut-liver-lung, and gut-liver-heart axes.

The international working group “Multi-Society and Multi-Stakeholder Consensus Revision of the NAFLD Nomenclature” proposed to replace the widely used term NAFLD - Non-alcoholic fatty liver disease with SLD - Steatotic Liver Disease - Steatous Liver Disease, using it in the form of an “umbrella” to include in this concept Metabolic and Alcoholic liver disease, its drug lesions and severe systemic diseases of the hepatic parenchyma.

Metabolic syndrome is a series of pathologies united by a similar pathogenesis, the end of which, most often, is cardiovascular accidents, which are leaders among the causes of death in the population around the world. Non-alcoholic fatty liver disease (NAFLD) is the hepatic equivalent of the metabolic syndrome, registered earlier than all other equivalents, on the rights of the liver as a first-line energy depot. At the same time, according to multicenter studies, 95% of people with NAFLD (any stage) are not diagnosed with the disease. Clarification of additional risk factors for NAFLD and the presence of a specific biomarker of non-alcoholic liver steatosis would make it possible to stop the vicious cascade of metabolic processes, which in the future can lead to a significant increase in the life expectancy of the population. The potentially high role of Secreted Frizzled Related Protein-4 (SFRP4) adipokine in the early diagnosis of NAFLD is known. The aim of the study was to optimize the early diagnosis of non-alcoholic fatty liver disease using modern indices and biomarkers. Materials and methods. The work was carried out at the Department of Faculty and Hospital Therapy of the Chuvash State University named after I. N. Ulyanov” in the period from 2016 to 2020. This study included several stages: first of all, a retrospective analysis of 1150 outpatient records of patients from several medical organizations of the Chuvash Republic for the period 2016-2018 was carried out. to form two study groups: experimental and control. At the second stage, as a result of applying the exclusion criteria, 162 people remained in the experiment: 110 from the experimental group, 52 from the control group. The subjects of both groups were compared by gender and age, the age range of the subjects varied from 18 to 80 years old with an average value of 48.3 years. Further, the patients undergo a detailed examination, according to the presented plan: Collection of complaints, medical history, objective examination. Laboratory studies (general and biochemical blood tests, lipidogram, assessment of the level of serum adipokine SFRP4). Instrumental studies (ultrasound of the OBP, TE (SAR), ESP with elastometry). Evaluation of the most informative complex indices for the early diagnosis of NAFLD: MI, IVO indices, HSI, FLD-I. Further, all the necessary statistical processing and analysis of the obtained data were performed (Microsoft Office Excel 2016, StatTech v. 2.8.8 (developer - Stattech LLC, Russia)). Results. Accessible (not requiring the use of additional time and material costs) NAFLD indices with the highest sensitivity rates (99.1% and 98.2%, respectively) were MI and IVO. A noticeable direct correlation was traced between MI (p=0.640), moderate - between the IVO (p=0.398) and the elastographically determined index of non-alcoholic liver steatosis. High sensitivity and specificity of skin manifestations (xanthoma, xanthelasma - 69.6% and 89.7% and seborrheic dermatitis - 82.0% and 71.4%) were found in relation to early manifestations of NAFLD. From anthropometric indicators: the CW/CF index has a pronounced (ρ=0.643), CW - moderate (ρ=0.238), and BMI - a weak direct (ρ=0.223) correlation with the elastographically determined index of non-alcoholic liver steatosis. Adipokine SFRP4 correlates (ρ=0.841) with early manifestations of hepatic steatosis in patients, as determined by TE in CAP mode.

Liver regeneration is an important task in the treatment of any liver diseases. The key point is the restoration of the liver structure, regression of fibrosis and steatosis of the liver. Difficulties in the treatment of patients with steatohepatitis of metabolic and alcoholic etiology are associated with comorbidity and multicomponent drug load, problems of lifestyle modification. The use of a complex parenteral drug in the treatment of this group of patients increases patient compliance, minimizes the risks of drug interactions. The aim of the study: to evaluate the effect of course treatment with Laennec on insulin resistance, dyslipidemia, systemic inflammatory response, activity of inflammatory process in the liver, steatosis and liver fibrosis. Materials and methods. The study included 50 patients with steatohepatitis of mixed etiology with the presence of biochemical activity, obesity, dyslipidemia, insulin resistance, are having liver steatosis and liver fibrosis of at least stage 1 (determined by liver fibroscopy). 32 patients received Laennec 6 ml intravenously 3 times a week, then 6 ml intramuscularly once every 10 days up to 24 weeks, 18 patients took Omega 3 PUFAs orally 2000 mg per day for 24 weeks. Results. Significant differences (p<0.05) in the estimated parameters in the group of patients treated with Laennec: decreased activity of the inflammatory process-ALT-21% AST -24%, CRP -21%; GGTP cholestasis syndrome -26%; insulin resistance index -13%; correction of LDL dyslipidemia -17%, triglycerides -17%, CA -18%; liver steatosis- 20%. There was an 8% decrease in triglycerides (p<0,05) in the group receiving Omega 3 PUFAs. Conclusions. The use of Laennec in patients with steatohepatitis initiates a decrease in the activity of the inflammatory process in liver tissue, improves metabolic parameters and liver structure.

Aim. Evaluation of the efficacy and safety of human placenta hydrolyzate (HPH) Laennec in the treatment of non-alcoholic fatty liver disease (NAFLD) in an experimental and clinical study. Material and methods. An experimental study was carried out on NAFLD models reproducible by administering various doses of CCl4 to rats. The clinical study involved patients with NAFLD (n=60, mean age 47±9 years) who were on a standard diet of the military hospital of the Republic of Vietnam. Half of the patients (n=30) received Laennec (2 ml/day IM, 4 weeks), while the other half were in the control group. The collected results were analyzed by standard methods of mathematical statistics. Results. Studies in a preclinical model of NAFLD in rats showed a significant reduction in the progression of liver fibrosis against the background of improved lipid metabolism. No negative effects of HPH on the nervous, cardiovascular and respiratory systems of animals have been established. In a clinical study, the mean levels of liver dysfunction markers (AST, ALT, GGT) of patients with NAFLD at the time of treatment initiation in both groups were significantly higher than the normal range (AST - 111±12 U/l, ALT - 103±8 U/l, GGT - 462±60 IU/l). The use of Laennec led to a significant decrease in the incidence of NAFLD symptoms (fatigue, a feeling of bloating in the abdominal cavity, anorexia) and a decrease in the levels of AST, ALT, GGT after a day of the therapy week. After 2 weeks of HLP therapy, there was a significant decrease in the levels of AST (53±4 U/l, control: 99±14 U/l, P<0.001), ALT (71±6 U/l, control: 92±7 U/l, P<0.001) and GGT (260±21 IU/l, control: 384±74 U/l, P<0.001). After 4 weeks of treatment, the parameters significantly decreased towards the lower limit of the normal interval: AST - 45±4 U/l, ALT - 52±5 U/l, GGT - 191±19 IU/l (all P<0.05 compared with the values at 2nd week) against the background of the absence of positive dynamics in the levels of AST, ALT, GGT in the control group. The use of the drug did not cause statistically significant changes in the parameters of clinical or laboratory hematological examination, urinalysis results, levels of other liver enzymes, as well as vital signs. Multivariate analysis showed that the effects of HPH are practically independent of age, gender, medical history, initial levels of AST, ALT, GGT, and other parameters of the biochemical blood test of patients. Conclusion. HPH Laennec is an effective and safe monotherapy for NAFLD.

The aim. To assess the severity of hyperammoniemia in patients with non-alcoholic fatty liver disease at the steatosis stage in conditions of comorbidity with stable angina. Research materials and methods. During the clinical trial, three groups of patients with stable angina were formed. Group I (n = 43) consisted of patients with NAFLD at the stage of hepatic steatosis in combination with obesity and a stable form of CHD. Group II (n = 41) - patients with NAFLD at the stage of hepatic steatosis against the background of normal body weight and stable CHD. Group III (control) (n = 42) - patients with stable angina without NAFLD, with normal body weight. The results of laboratory examination (clinical and biochemical blood tests, lipidograms, insulin levels (calculated by HOMA-IR), glycosylated hemoglobin (HbAlc)) were evaluated; non-invasive markers for the diagnosis of liver injury. Hyperammonemia was evaluated by quantitative rapid ammonia analysis using a Pocket Chem TM BA PA-4140 analyzer. All patients underwent ultrasound of the liver using Philips Epiq 5 (USA). Results. In all patients with stable angina (group I and II), the diagnosis of non-alcoholic fatty liver disease, steatosis stage, was confirmed. The lipid profile of patients in Groups I and II showed more significant hypertriglyceridemia compared to those in the control group, with no statistical difference in Groups I and II. The mean ammonium level in patients with NAFLD in combination with stable CHD (group I, II) was above the threshold and was 87 (57-127.5) and 79 (57-97) μmol/L, respectively, and did not differ significantly (p > 0.05). In patients of group III (without liver disease), the mean values of ammonia in the blood were in the target range. According to the results of correlation analysis, we established the relationship of ammonium with liver enzymes, calculated steatosis indices and basic metabolic indicators. Conclusion. Patients with non-alcoholic fatty liver disease in the steatosis stage with a combination of stable angina have more severe hyperammonemia compared to patients with stable CHD without concomitant liver injury.

The paper presents the results of an assessment cognitive function and ammonium levels in individuals who have had a novel coronavirus infection (COVID-19). The study included 60 people: 41 - confirmed COVID-19 during last 3 months and 19 - the control group. There have been performed clinical examination, psychometric test - connect-the-numbers test (CNT) and Mini-Mental State Examination (MMSE). Blood ammonium level has been determined. Post-COVID-19 syndrome (PCS) was diagnosed in 70.7% of patients, which was manifested by complaints of memory loss, weakness and anxiety. In patients who underwent COVID-19, cognitive impairment was detected on the MMSE scale in 27 people (45%), and the changes were more pronounced in the group with PCS. In the post-COVID group, 66% of the subjects had an increase CNT result. The cognitive impairment according to the MMSE correlated with the CNT results. Hyperammonemia was found in 54% of COVID-19 survivors, with higher values observed in the PCS group. No correlation was found between hyperammonemia and cognitive impairment.

The aim. To study the clinical manifestations and features of changes in the spectrum of the bile acids in bile and blood in patients with non-alcoholic fatty liver disease. Materials and methods. 54 patients with non-alcoholic fatty liver disease at the stage of steatosis were examined. The median age was 50 years (45; 55). Complaints, objective symptoms and the results of laboratory and instrumental studies of the liver were used to verify non-alcoholic fatty liver disease. The content of the bile acids in bile and blood was determined using an AmazonX mass spectrometer (Bruker Daltonik GmbH, Bremen, Germany). Results. The majority of the examined patients (77,8%) with non-alcoholic fatty liver disease had subjective and objective symptoms of damage to the hepatobiliary system and intestines. According to the results of mass-spectrometry, a decrease in the total amount of primary free bile acids (cholic, chenodeoxycholic) and an increase in the total content of conjugated bile acids (glycocholic, glycodeoxycholic, taurocholic, taurodeoxycholic, ursodeoxycholic) in portions “B” and “C” bile, as well as blood compared with the control group. The concentration of acids conjugated with glycine was higher than that of taurine conjugates, while the correct ratio of glycine conjugates to taurine was observed (3: 1 and higher). Conclusion. Changes in the spectrum of the bile acids in bile and blood, firstly, is an indicator reflecting the violation of enterohepatic circulation, and, secondly, demonstrates the increasingly obvious importance of the bile acids in the pathogenesis of non-alcoholic fatty liver disease.

Introduction. Rosacea is a very common disease among dermatological diagnoses, it is from 5% to 20%. Dysfunctional disorders of the gastrointestinal tract are described in rosacea and chronic opisthorchiasis (HO). The study of gastrointestinal pathology as a factor aggravating the course and manifestation of rosacea on the background of HO, is of practical interest. Purpose of research. To study the features of the gastrointestinal tract in patients with rosacea in combination with HO. Materials and methods. 144 patients were examined, including the 1st group consisted of 80 patients with rosacea without opisthorchiasis, the 2nd group-64 patients with rosacea in combination with HO. 3rd control group - 20 healthy volunteers. Patients underwent duodenal intubation with microscopy of bile; ultrasound examination of abdominal cavity; FGDS with the use of endoscope “Olympys” with biopsy of fondling and pyloric stomach; the complex of histological and histochemical methods; the index of the SHDOR to determine the severity of rosacea. Results. Clinical manifestations of rosacea in patients with HO were more pronounced, as evidenced by a high index of SHDOR 11.3 (6;16) points compared to group 1 (p<0.001). In most patients of group 2, according to ultrasound data, changes in the hepatobiliary system (85.9%) and according to the data of the FGDS (96.8%), pathology of the upper gastrointestinal tract (p<0.001) were detected, which was significantly higher than in patients of group 1 and due to the presence of HO. In patients of group 2, histological changes in the stomach were inflammatory-degenerative. Summary. Examination of the gastrointestinal tract (duodenal sounding with microscopy of bile, ultrasound, FGDS) in patients with rosacea in combination with HO is recommended in practical health care, which will contribute to timely deworming, and as a consequence, positive dynamics in the clinical course of rosacea.

In this paper we discuss classical types of acute glomerulonephritis in young adults, when the intake of paracetamol and diclofenac led to a dysfunctional and organic liver injury, at the same time it negatively affected the course of acute glomerulonephritis. To study the characteristics of the development of acute reno-cardial syndrome (ARCS) Goal: Assessment of cause and effect relations of renal, hearts and liver injuries in young adults in acute post-streptococcal glomerulonephritis (APSG). With acute nephritic syndrome (ANS) complicated by acute kidney injury (AKI) and without it, to identify the role of the etiological factor on the course of APSG. Methods and Material: 220 male patients with APSG with ANS aged 18-20 were examined. The patients were divided into 2 groups based on the functional state of kidneys. The first group included 140 patients with APSG without ANS, the second group included 80 patients with AKI. Results: Out 66 patients had subclinical liver injury, which resulted from the effect of antipyretic hepatotoxic drugs taken in the initial stage of the disease. Due to the toxic and immunological liver injury, levels of transaminases increase, and albumin levels decrease. These changes occur along with the development of APSG and are correlated with some laboratory values. Impairment of cardiovascular function was observed in all 220 patients. ECG and Echocardiography studies conducted during the cardiac asthma attacks occurred as a decrease of voltage, broadening of the P wave, lengthening of the PQ interval, broadening of the QRS complex, dilatations of the right and left atrium. The severity of clinical manifestations of AKI and ARCS correlates with the degree of macrohematuria, GFR decrease, complement C3 fraction, monocyte. Conclusion. In APSG liver injury has a toxicoallergic character. Frequency of liver injury depends on specific features of a particular organism, it does not depend on the dose of the taken drug. In case of any type of acute glomerulonephritis it is necessary to assess the functional state of liver and after the treatment of the main disease hepatologist follow-up of patients is recommended. Thus in the development of acute reno-cardial syndrome (ARCS) the degree of manifestation of hypervolemia with hypertension, as a result of active immune inflammation of the glomerular apparatus with the development of AKI, plays the main role in the development of ARCS with APSG.. As a rule ARCS in case of APSG with ANS in young adults has a successful outcome.

The aim of the study was to evaluate the effectiveness of a metabiotic based on Bacillus subtilis biologically active food supplement “Baktimunal” in the treatment of patients with NAFLD. Materials and methods. Baktimunal was received by 40 patients with NAFLD: 26 (65.0%) women, 14 (35.0%) men, aged 56.09±8.92 years. The diagnosis of NAFLD was verified on the basis of traditional clinical, laboratory and sonographic data. Initially and at the end of therapy, along with functional liver tests, the following indicators were determined: the level of endotoxin in the blood using the test systems “ELISA Kit for Lipopolysaccharide (LPS) Cloud-Clone Corp. USA”, fatty liver index (FLI) and fibrosis index FIB-4. Baktimunal was prescribed 1 capsule 2 times a day for 6 weeks. The control group consisted of 12 healthy donors, their endotoxin level was 0.07±0.05 pg/ml. Results. A positive clinical and laboratory effect of Baktimunal was noted in 32 (80.0%) patients: the level of endotoxin decreased from 0.19±0.06 pg/ml to 0.13±0.05 pg/ml (p<0.05), alanine aminotransferase - from 55.06±22.14 U/l to 38.8±20.49 U/l (p<0.05), glycemia - from 8.34±1.28 mmol/l to 7.42± 1.12 mmol/l (p<0.05), the level of lymphocytes increased from 2.54±0.41x109/l to 3.01±0.58x109/l (p<0.05), monocytes - from 0 .53±0.23x109/l to 0.77±0.19x109/l (p<0.05). There was a trend towards normalization of dyslipidemia, a decrease in FLI and FIB-4. Conclusion. The effectiveness of Baktimunal was noted in 80.0% of NAFLD patients, it was characterized by a decrease in the level of metabolic endotoxicosis, hepatocellular inflammation, glycemia and an increase in innate immunity cells.

He aim of the study was to determine the role of polymorphisms of the GGT1 gene and environmental risk factors in the acute biliary pancreatitis. The material of the study was DNA samples obtained from 84 patients with ABP and 573 healthy individuals. The disease was diagnosed using clinical guidelines (Russian Society of Surgeons). To assess the associations of alleles and genotypes of the gene with the risk of acute pancreatitis, the χ2 test and the odds ratio (OR) with 95% confidence intervals (CI) were used. Statistical analysis was carried out using the Statistica 10.0 program (StatSoft, USA) and the SNPStats program. Results. It was found that the A/A-G/G rs5760489 and A/A rs4820599 GGT1 genotypes have an increased risk of ABP. The H3 A-A-A-A haplotype is associated with a reduced risk of the disease, while the H6 A-G-A-A haplotype, on the contrary, increases the risk of developing the disease. The absence of exposure to alcohol abuse reduces the risk of ABP in carriers of the genotypes A/G-G/G rs5760489, A/G-G/G rs4820599, smoking -A/G-G/G rs4820599 and A/G-G/G rs5760489. The A/G-G/G rs4820599, G/A-A/A rs5751909 and A/G-G/G rs5760489 genotypes have a protective effect with sufficient consumption of fresh vegetables and fruits, the main suppliers of glutathione to the body. The presence of glutathione deficiency leads to the oxidative stress, and phenotypic changes we found: leukocytosis (allele A, rs5760489), peritonitis (allele A, rs5751909). Conclusion. The GGT1 gene can be used to predict the development and clinical course of acute biliary pancreatitis and its complications.

Purpose of the study. To evaluate the intensity of blebbing of the plasma membrane of lymphocytes and the formation of microparticles of lymphocytic origin in patients with postresection hepatic failure. Material and methods. The study involved 54 patients with focal liver diseases. The study involved 32 (59%) women, 22 (41%) men. The average age was 59.5 [49.75; 66,00]. Patients were divided into groups, 1 group - 10 patients with developed acute liver failure and 2 group - 44 patients with a favorable course of postoperative period. The following surgical interventions were performed: 36 (67%) patients underwent surgery - laparotomy, segmental liver resection, 10 (18%) - left-sided hemihepatectomy and 8 (15%) - right-sided hemihepatectomy. Results. Predictors of early postoperative hepatic failure are a decrease in initial blebbing and an increase in terminal blebbing and free microparticles of lymphocytic origin. Conclusions. Thus, changes in lymphocyte blebbing and the presence of free microparticles of lymphocytic origin are due to the development of endothelial insufficiency and apoptosis of lymphocytes in the context of liver failure and are determined by the reduced function of residual liver volume.

Aim of this work is to pay attention to tactical approaches to patients with gallbladder polyps. Materials and methods. Authors analyze the experience of surgical treatment of 84 patients with gallbladder polyps for the period 2015-2021 yy. at the University Clinic. Results. Histological examination showed that hyperplastic polyps met most frequently in 47.6%, adenomatous polyps occurred in 45.3% and cholesterol (cholesterosis) in 7.1%. Conclusions. Gallbladder polyps have no specific symptoms. The potential for malignant transformation implies an active surgical approach, which leads to an increase in the number of surgical benefits. At the same time, minimally invasive, videoendoscopic technologies have sufficient capabilities for the radical removal of gallbladder polyps.

The study aims to study of changes in transcriptional activity of oxidative stress genes in acute toxic hepatitis. Materials and methods. The study material was white mongrel male rats weighing 180-200 grams. The studied toxicants were: carbon tetrachloride, ethanol, acetaminophen. As hepatoprotectors were introduced: oxymethyluracil, ademethionine and ethylmethylhydroxypyridine succinate. RNA was isolated, which was subjected to reverse transcription. RT-PCR was performed using a real-time PCR system in the presence of SYBR Green. GAPDH was used as a normalized control. The expression of the studied genes was evaluated by PCR analysis using pre-selected primers. Statistical significance was checked using IBM SPSS Statistics software. Results. In comparison of experimental groups, statistically significant differences were found in the level of expression of the CASP7 gene. Transcriptional activity of the CHEK gene (k=11.25; p=0.024). The GCLC gene (k=21.70; p=0.001) reached its minimum value of -3.6 [-3.72; -3.32] in the Mexidol group. The multiplicity of expression of the GSTM1 gene (k=15.54; p=0.004) had the highest value -0.14 [-1.11; 1] in the group that did not receive TCM. The NQO1 gene achieved its statistical significance in a 72-hour experiment (p=0.005). Statistical analysis of the RIPK gene showed significant differences. The expression level of the GSTP1 gene (k=10.39; p=0.034) reached its maximum value in the untreated group of 0.03 [-0.74; 0.48]. Expression of the NFE2L2 gene with acetaminophen administration showed the following results (k=13.64; p=0.009). Glutathione activity (k=10.29; p=0.036) reached its minimum value in the group receiving Mexidol -1.6 [-1.7; -1.29]. The multiplicity of superoxide dismutase expression showed statistical significance (p=0.003). Conclusions. Markers of the clinical course, prognosis and outcomes of toxic hepatitis were found. These data make it possible to determine the severity of the disease at the stage of early molecular response, when active clinical symptoms have not yet developed, which makes it possible to prescribe targeted therapy and adjust treatment tactics.

The aim. To study functional-morphological and biometric changes in the liver and lipid spectrum in an experiment in male and female laboratory rats when modeling fructose-induced liver steatosis. Materials and methods. The experimental study was conducted on 44 non-inbred sexually mature white rats, of which 20 were males aged 8-9 months with a body weight of 400-530 g. and 24 females aged 9-10 months with a body weight of 320-480 g. Modeling of liver steatosis was carried out for 28 days by adding fructose to drinking water throughout the experiment using 15%-th solution of fructose instead of drinking water. At the end of the experiment, body weight was measured, liver sampling for morphometric and histological studies and blood sampling for laboratory studies (transaminase, glucose and lipid spectrum levels) were performed. Results. When comparing body weight before the experiment and after its completion, a statistically significant increase in this indicator was found in females with experimental steatosis (p = 0.031), which indicates the formation of general obesity in them. The mass coefficient of the liver in the experimental groups of males and females with steatosis was significantly higher than in the controls (p= 0.009 and p = 0.009, respectively). During histological examination of liver tissue, the number of hepatocytes with steatosis in males and females in experimental models was significantly higher than in control groups and corresponded to the II-III degree of steatosis. A comparative analysis of the lipidogram parameters revealed that dyslipidemia developed during the formation of liver steatosis in animals of both groups with fructose-induced liver steatosis. Conclusion. In experimental modeling of fructose-induced liver steatosis in animals, regardless of gender, morphological changes in liver tissue are manifested by fatty dystrophy and hepatomegaly, dyslipidemia is registered. At the same time, males develop fermentemia, hyperglycemia without the formation of general obesity. In females, the course of experimental steatosis is accompanied by an increase in body weight without functional changes in the liver.

The review article discusses the modern pathogenetic links of biliary gastritis, namely the role of endothelial dysfunction, intestinal metaplasia in inflammation and the influence of Helicobacter pylori infection. The problem of combined damage to the mucous membrane of HP-associated and biliary gastritis remains relevant, since modern foreign studies have not come to a consensus, but most authors state increased carcinogenesis of the stomach with a positive HP status against the background of the course of pathological duodenogastric reflux. The article also presents original materials of histological examination of biliary, HP-associated, autoimmune and hyperplastic gastritis with similar morphological features, thereby demonstrating the difficulties of differential diagnosis.

Glycyrrhizinic acid is a triterpenoid plant-derived compound with potent antisteatotic, anticytolitic, anti-inflammatory, antifibrotic, anticholestatic as well as antiapoptotic, antineoplastic and some other effects. Recent studies have demonstrated glycyrrhizinic acid to form supramolecular self-associates and micelles, which makes it a pharmacokinetic, and, hence, a pharmacodynamic enhancer. Thus, the prospects and possibilities of combined use of glycyrrhizinic acid in liver disease and other pathologies arise due to the pharmacological properties of the molecule itself as well as its function as drug carrier and delivery enhancer. The present review is focused on the pharmacodynamic and pharmacokinetic features of glycyrrhizinic acid combinations with essential phospholipids and ursodeoxycholic acid.

The study of cytokine production and its genetic regulation in diseases of various pathogenesis in childhood, which include several mechanisms of inflammation - this is autoimmune against the background of celiac disease, type 1 diabetes and CAI, lymphoproliferative against the background of oncohematological diseases, microbial-inflammatory against the background of chronic pyelonephritis and cystic fibrosis and metabolic against the background of obesity and a decrease in bone mineral density is necessary to expand understanding of pathogenesis, predict variants of the clinical course of diseases (clinical phenotypes) and complications, as well as response to therapy. The literature review is devoted to the analysis and interpretation of data on the effect of vitamin D supply and its genetic regulation on the course of diseases, combined according to the leading pathogenetic mechanism of inflammation into autoimmune, microbial, and lymphoproliferative models.

Alcoholic liver disease (ALD) - damage to the liver parenchyma under the influence of ethanol consumption, which can manifest itself in several ways: steatosis, alcoholic hepatitis (steatohepatitis), fibrosis and cirrhosis of the liver. The present review considers publications of recent years (2020-2023) in the Pubmed and Scopus information databases devoted to the study of various aspects of the current state of the problem of alcohol-associated liver pathology. New data on the epidemiology and burden of ALD have been obtained; the pandemic of a new coronavirus infection has had a certain impact on the course of ALD. The study of individual links in the pathogenesis of ALD is actively continuing, a large number of publications are devoted to the participation and role in the pathogenesis of alcohol-associated liver diseases of the “gut-liver” axis. New therapeutic strategies for alcohol-associated liver disease are classified based on their mode of action: (1) anti-inflammatory therapies, (2) antioxidants, (3) therapies that modulate the gut-liver axis, and (4) therapies that enhance liver regeneration. At the same time, the often unfavorable prognosis and insufficient effectiveness of therapy require further study of alcohol-associated liver diseases.

Dietary supplements are often self-administered by patients for weight loss. However, the hepatotoxicity of such supplements remains underestimated. Liver damage is diverse: from asymptomatic reversible course to lethal fulminant hepatitis. In the case of a long unrecognized course and prolonged use of dietary supplements, irreversible structural and functional damage to the organ occurs. We present a retrospective analysis of the case histories of a patient with liver cirrhosis, who has a long history of using dietary supplements of Thai and Chinese origin, hellebore extract, during 5 years of follow-up. Despite the discontinuation of weight loss drugs, regular complex therapy, the patient has a steady progressive course of the disease. Obese patients with an increased risk of liver damage require a dynamic assessment of liver function, not only when prescribing drugs, but also when using various dietary supplements.

Introduction. An increase in bilirubin and liver enzyme activity may be one of the side effects of statin therapy, often occurring in patients after AMI and coronary artery stenting, or in high and very high risk individuals on high and moderate intensity statin therapy. The frequency of occurrence of increased transaminases and bilirubin is according to different authors. Therefore, in terms of differential diagnosis, the cardiologist should consider Gilbert’s syndrome as a possible cause of hyperbilirubinemia. Description of the clinical case. The article considers a clinical case of differential diagnosis of non-conjugated hyperbilirubinemia detected in a patient after coronary artery stenting. The level of hemoglobin, erythrocytes, reticulocytes did not differ from normal values and did not change over time. This made it possible to exclude the hemolytic genesis of hyperbilirubinemia. Genetic testing was used to establish the homozygous form of Gilbert’s syndrome. However, the presence of fibrotic changes in the liver, an increase in not only unconjugated, but also conjugated bilirubin, hypertriglyceridemia, dyslipidemia, and stenosing atherosclerosis of the coronary arteries did not allow us to state that the patient had only Gilbert’s syndrome. Discussion. According to recent studies, this disease is characterized by a benign course and reduces the risk of developing cardiovascular diseases due to the antioxidant effect of bilirubin. In addition to Gilbert’s syndrome, the patient was diagnosed with an erased form of non-alcoholic fatty liver disease associated with metabolic syndrome. Conclusion. The disease was caused by insulin resistance, a high-calorie diet, excess consumption of saturated fats, refined carbohydrates, and a sedentary lifestyle. The drugs of choice in this case are statins, ezetemibe, and ursodeoxycholic acid. Their appointment allows not only to reduce cardiovascular risk, but also to slow down the further progression of liver fibrosis.

In many countries fix cases of severe liver damage in children are recorded. A previous or existing coronavirus infection leads to a disruption in the body’s immune response to infections, which can lead to severe inflammation that caused liver damage. This article describes a clinical case of type 2 autoimmune hepatitis, a high degree of biochemical activity, that debuted in an 11-month-old child after a new coronavirus infection (COVID-19). The presented clinical example demonstrates the need for a thorough and comprehensive examination of children with the first clinical manifestations of liver damage and timely prescription of therapy