Background: One of the most controversial topics in the scientific community of urologists, cardiologists and endocrinologists is the problem of the estrogen role in the male body. There are significant differences in the development and evolution of a number of diseases, for example, cardiovascular, in men and women. In particular, mortality in middle-aged and young men from diseases of the ardiovascular system is significantly higher than in women, which can be attributed to the difference in the levels of sex hormones - androgens and estrogens. According to the world scientific community, estrogens in women perform an obvious protective role, which is associated with the rarer development of cardiovascular diseases (CVD) in the reproductive period. Why, then, the shift in the balance of androgens and estrogens in men in favor of the latter not only does not give advantages in terms of protection of the cardiovascular system, but, on the contrary, increases the risks. It is common that hyperestrogenism in the male body is associated with an increase in the volume of adipose tissue and, consequently, an unfavorable profile of metabolic parameters. In the same time there is currently no coherent generally accepted concept about the negative effects of estrogens in men in the light of cardiovascular risks and possible ways to correct this condition. The purpose of the review: to determine the presence of an association of estradiol levels as the most active estrogen with cardiovascular diseases in men.

Relevance. Recently, the attention of researchers has been focused on finding the pleiotropic effects of gliflozins, which include potential therapeutic efficacy against non-alcoholic fatty liver disease (NAFLD). NAFLD is considered not only as an independent risk factor for the development and progression of liver dysfunction, but also cardiovascular diseases. Objective. To evaluate the effect of dapagliflozin after 12 weeks of use on clinical and biochemical parameters, body composition and the degree of liver fibrosis in patients with chronic heart failure with preserved ejection fraction (HFpEF) in combination with NAFLD. Material and methods. A prospective, randomized, open-label study in parallel groups involving 60 patients with HFpEF in combination with NAFLD. The main group received dapagliflozin 10 mg once a day in addition to standard therapy for 12 weeks. The main evaluation parameters were biochemical parameters, non-invasive indices of liver fibrosis assessment, clinical manifestations of chronic heart failure (CHF) and body composition according to bioimpedance measurements. Results. In the main group, a statistically significant decrease in ALT from 48.5 [12.0; 66.0] to 29.5 [11.0; 46.0] U/L, p=0.031, AST - from 47.0 [21.0; 69.5] to 25.5 [10.0; 44.5] U/L, p=0.011), total bilirubin from 16.6 [7.6; 18.1] to 11.3 [3.6; 14.1] mmol/L, p=0.047 and TG - from 1.2 [0.8; 1.8] to 0.9 [0.8; 1.2] mmol/l, p=0.022; decrease in the FIB-4 index from 1.44 [0.94; 3.01] to 1.18 [0.64; 3.11], p=0.022; BARD scale - from 1 [0; 2] to 0 [0; 2], p=0.028; NFS scale - from -1.435 [-1.634; 0.665] to -1.616 [-1.852; 0.365], p=0.040; decrease in body mass index (BMI) from 29.6 [25.5; 33.1] to 27.1 [22.2; 31.0] kg/m², p=0.047; waist circumference (WC) - from 99.5 [91.5; 104.5] to 96.5 [89.5; 100.5] cm, p=0.044 and percentage of body fat according to bioimpedancemetry - from 22.3 [19.5; 25.6] to 20.3 [17.4; 23.9]%, p=0.022. Dynamics of functional class CHF from II to I was revealed in the main group, p<0.05. Conclusion. Taking dapagliflozin for 12 weeks in patients with CHFpEF and NAFLD was accompanied by a decrease in liver transaminases, plasma TG, hepatoprotective antifibrotic effect (FIB-4 index, NFS and BARD scales), a decrease in BMI, WC and percentage of body fat, as well as regression of clinical symptoms of CHF.

The purpose of this study is to present the results of a comparative assessment of the effect of intermittent restricted diet (ICR) with a constant restricted diet (CCR) on weight loss, fat mass, the effect on cardiometabolic risk markers, glucose and insulin levels in obese adults. Materials and methods: The works cited in the study were selected using the keywords “obesity”, “comorbidity”, “weight loss”, “intermittent calorie restriction”, “constant calorie restriction”, in the search engines PubMed, Scopus. Publications had to meet the following criteria: randomized clinical trials, published in the last decade (2014-2024), access to the full text of the publication, the primary endpoint of weight loss, intermittent or continuous calorie restriction as the main intervention, adult population, subjects with obesity and comorbid pathology. Results: Obesity has acquired pandemic proportions worldwide. In some countries, prevalence rates range from 20 to 40%. Prevalence and incidence rates continue to increase. It is estimated that by 2030, almost 50% of the world’s population will be overweight or obese. Obesity increases the risk of a number of chronic noncommunicable diseases (T2DM, CVD, CKD, CLD, some types of cancer). Weight loss is the main intervention for people with overweight and obesity. Conservative non-drug therapy in the form of nutritional modification is the mainstay of obesity treatment and is recommended as the first, mandatory and permanent component of treatment. Daily caloric restriction and intermittent feeding are two forms of dietary therapy that can help to reduce body weight. Conclusion: Based on the results of the comparative analysis, we concluded that ICR and CCR are alternative energy restriction regimens for weight loss with comparable improvements in obesity-related cardiometabolic risk markers. Both regimens were well tolerated in most studies and may be equivalent approaches to weight loss. Further studies are needed to examine the efficacy, feasibility and safety of ICR in patients with chronic diseases such as type 2 diabetes, cardiovascular disease or cancer.

This review article examines the endocrine gastroenterological aspects of metabolic dysfunction, which is a complex pathological condition that affects metabolism and is accompanied by disturbances in the functioning of the endocrine system. The introduction focuses on key hormones such as insulin and leptin and their roles in regulating metabolism and digestive processes. The consequences of disturbances in the secretion of these hormones, including the development of type 2 diabetes mellitus and obesity, are discussed. The article offers a comprehensive analysis of the relationship between endocrine disruption and gastroenterological problems such as irritable bowel syndrome, highlighting the importance of further research to understand the mechanisms underlying these diseases. The results of this review can serve as the basis for the development of new approaches to the diagnosis and treatment of metabolic disorders, as well as for the formation of strategies for the prevention of associated diseases.

Endocrine gland disorders increase the risk of developing anemia and are an independent cause of their occurrence. Of all endocrine diseases, diabetes mellitus and diabetic nephropathy, hypothyroidism, adrenal insufficiency, and hypogonadism contribute most to the development of anemia. The pathophysiological basis for the occurrence of anemia in these conditions is multifactorial and requires further investigation. Endocrine diseases lead to the development of microcytic, normocytic, macrocytic and hypochromic, normochromic, hyperchromic anemias. The resulting anemia leads to aggravation of the course of the underlying disease, thus closing the vicious circle. Simultaneous and complex treatment of both endocrine pathology and anemia leads to more successful correction of anemia.

Non-alcoholic fatty liver disease (NAFLD) encompasses a range of diseases, including non-alcoholic fatty liver and non-alcoholic steatohepatitis (NASH), potentially leading to cirrhosis and hepatocellular carcinoma. Globally, approximately 30% of the population suffers from NAFLD, with recent data indicating an increasing prevalence. The increasing incidence of NAFLD and its complex relationship with metabolic dysfunction highlight the risk of liver cirrhosis in patients with different BMIs who are not provided with timely diagnosis and therapy. Therefore, it is critical to prioritize prevention and screening measures for NAFLD. The purpose of our work was to determine risk factors for the development of NAFLD with and without obesity. Materials and methods. A one-time study was carried out with a comprehensive assessment of nutritional status, including anthropometry, bioimpedansometry and assessment of actual nutrition, as well as a study of the level of biochemical and hormonal indicators on the basis of the Regional Clinical Hospital of War Veterans No. 3 in Novosibirsk. A total of 349 people took part in the study. Of these: 113 patients with NAFLD without obesity, 122 patients with NAFLD with obesity according to BMI and 114 apparently healthy people. Results and its discussion. In the course of multivariate regression analysis, models were identified that combine a set of factors influencing the development of non-alcoholic fatty liver disease in patients with different nutritional status. For patients with NAFLD without obesity, the factors for the development of the disease are: excess dietary cholesterol intake EXP(B) = 1.004 95CI [1.001-1.008], HOMA -IR index EXP(B) = 20.535 95CI [5.893-71.551], total cholesterol level EXP (B) = 5.092 95CI [2.226-11.649], gamma-glutamyl transpeptidase (GGTP) EXP(B) = 1.282 95CI [1.155-1.423] and visfatin EXP(B) = 1.117 95CI [1.067-1.107]. In patients with NAFLD in combination with obesity, the risk factor model consisted of total fat mass according to bioimpedance measurements EXP(B) = 1.288 95CI [1.123-1.477], HOMA-IR index EXP(B) = 13.318 95CI [3.045-58.242], level GGT EXP(B) = 1.388 95CI [1.185-1.626] and visfatin EXP(B) = 1.193 95CI [1.063-1.338]. Conclusion. Thus, patients with NAFLD, depending on BMI, have a different combination of risk factors, the model of which includes both important features of nutritional status and metabolic and hormonal disorders that underlie the formation of the disease as a whole. The resulting combinations of factors can be used for early diagnosis of NAFLD in patients with both obesity and normal body weight as an expanded screening.

Aim. To evaluate the features of the relationship between changes in the composition of the colon microbiota and factors of immunological reactivity in obesity in young people. Materials and methods. The study involved 87 obese people (BMI 37.2 [34.1; 42.05] kg/m2) and 31 people with normal body weight (BMI 21.9 [20.2; 23.5] kg/m2). The participants underwent a study of lipid metabolism, cytokine profiles, immune status, and the composition of the colon microbiota was determined. The Microsoft Excel 2010 and IBM SPSS Statistics 26.0 application software package was used for statistical calculations. The results were evaluated as statistically significant at a level of p<0.05. Results. When analyzing the microbiota, in the obesity group compared to the control group, a statistically significant decrease in the bacteria Faecalibacterium prausnitzii and an increase in the bacteria Prevotella spp and Fusobacterium nucleatum were revealed. Associations of these microorganisms with the most important parameters of nonspecific and specific immunological reactivity were identified. In particular, a correlation between Prevotella spp and CRP, NBT spontaneous activity of neutrophils and the stimulation index of the NBT test of neutrophils has been traced. A. muciniphila correlated with MCP-1 and F. nucleatum - with Ig M. A large number of correlations have been identified in F. prausnitzii with indicators of cellular nonspecific and specific immunological reactivity. Thus, F. prausnitzii correlated with NBT-induced monocyte activity (%), NBT-induced neutrophil activity (%), phagocytic activity of neutrophils (%), phagocytic number of neutrophils, phagocytic number of monocytes, T-NK lymphocytes (CD3+16+56 +) (%; cells/µl), T-lymphocytes with the CD3+25+ phenotype (%; cells/µl) and T-lymphocytes with the CD3+HLA DR+ phenotype (%; cells/µl). Conclusion. The results of the study indicate the presence of associations of colon microbiota with the mechanisms of immunological reactivity in obesity in young people. The data obtained confirm the presence of a low-intensity chronic inflammatory process in obesity, the basis of which is the adaptive reactions of the immune system.

Purpose. To Assess of the prevalence of hypertension and associated obesity as the main risk factors among the population of the Navoi region, as well as the frequency of associated clinical conditions among patients with hypertension. Materials and methods. The study were based on the results of a study from the unorganized male and female population living in the city of Navoi and rural areas for 2023. The selection of samples followed standard methods and was carried out in one stage. One randomly selected medical district in the city and rural areas was selected, serving from 1.8 to 2 thousand people (range 19-64 years). Results. Our study showed that the prevalence of hypertension among the examined individuals in the urban population was 35.2%, and in the rural population - 27.9%. According to the data obtained, the prevalence of hypertension prevails among the urban population compared to the rural population (35.3% and 28.0%; respectively, p < 0.05). Conclusion. Timely assessment of the epidemiological situation with analysis of the causes of the disease, associated comorbid conditions, complications and mortality, competent choice of antihypertensive drugs, and correction of existing risk factors should lead to a significant reduction in the risk of cardiovascular complications.

Background: Obesity is one of the most common diseases in the world. According to the World Health Organization (WHO), 890 million people were suffering from it in 2022. Among them, the proportion of childhood obesity is 8,24%. Over the past 32 years, the proportion of childhood obesity has increased by 6% and 160 million children were suffering from it by 2022. According to the dynamics of the prevalence of the disease, WHO assumes that by 2035 the number of children and adolescents from 5 to 19 years old who are obese or overweight will increase to 61% in boys and 75% in girls. According to WHO data, the incidence of childhood obesity in Russia ranged from 4,45% to 8,4% by 2022. In the structure of morbidity, males predominate over females in the ratio 2:1. One of the most common comorbid pathologies in obesity is metabolically associated fatty liver disease (MAFLD), the prevalence of which, to date, cannot be estimated due to insufficiently accurate research methods. At the moment, there are no clinical recommendations that would standardize the approach to the diagnosis and treatment of this comorbid pathology, and the question of the terminology of the disease is still relevant. Early detection and therapy of MAFLD will help prevent the development of irreversible liver changes.

The concept of metabolic syndrome (MS) has existed since the 1980s and in its classical version includes obesity, lipid and carbohydrate metabolism disorders, and arterial hypertension (AH). Later (since 2009), non-alcoholic fatty liver disease (NAFLD) was considered as the fifth component of MS, which is currently proposed to be renamed steatotic liver disease by the International Working Group “Multi-Society and Multi-Stakeholder Consensus Revision of the NAFLD Nomenclature”. NAFLD and AH are pathogenetically interconnected through insulin resistance, systemic inflammatory response and oxidative stress, progressive endothelial dysfunction, impaired vasoconstriction and vasodilation mechanisms that develop against the background of liver fibrogenesis, which is described in detail in this article. Patients with hypertension and NAFLD often have unstable hypertension with episodes of hypotension, and insufficient effectiveness of antihypertensive therapy. NAFLD itself is associated not only with an increased risk of cardiovascular events, but also with other cardiac complications, regardless of traditional cardiovascular risk factors. At the same time, hypertension increases the risk of liver cirrhosis and, in addition, hypertension is independently associated with the development of severe liver diseases. In other words, the combination of NAFLD and hypertension in a patient worsens the course of both pathologies and the patient’s prognosis, especially with progressive fibrosis in the liver. Pathogenetically substantiated drugs of choice in the treatment of hypertension in a patient with NAFLD are drugs that affect the renin-angiotensin system, which will also be discussed in this article.

Relevance. Metabolic-associated steatotic liver disease (MASLD) became the first pathology among all liver diseases with a tendency for further increase in incidence. Patients with MASLD and normal weight are a special cohort that is difficult to diagnose and treat. The purpose: to analyze the literature about pathogenesis, prognosis of the disease and management of lean patients with MASLD. Materials and methods. The search of the literature devoted to NAFLD or MASLD was conducted in the PubMed and Google Scholar databases, these articles included adult patients with a body mass index of less than 25 kg/m2 for the general population and less than 23 kg/m2 for the Asian population. Discussion. MASLD is observed mainly in individuals with obesity and/or type 2 diabetes mellitus, but 7%-20% of patients with MASLD have a normal weight. This is a specific disease phenotype with a complex pathogenesis including visceral obesity, sarcopenia, genetic polymorphism, altered microbiota profile and behavioral factors. Lean patients with MASLD have a high prevalence of metabolic disorders (arterial hypertension, dyslipidemia, type 2 diabetes mellitus) and increased mortality from cardiovascular diseases, liver diseases and all causes, compared with healthy people. They can develop the same spectrum of liver damage (steatohepatitis, fibrosis, cirrhosis) as individuals with MASLD and obesity. The article describes diagnostic approaches for MASLD in lean people, requiring the exclusion of alternative causes of steatosis, as well as the high risk groups identification. The treatment challenges are the lack of effective pharmacological therapy, the necessity of metabolic factors and lifestyle modification. Conclusion. The obtained data do not allow us to consider MASLD in lean patients as a benign disease. In this cohort, it is necessary to diagnose the stage of liver damage and to screen for cardiometabolic disorders early.

Sarcopenia and non-alcoholic fatty liver disease (NAFLD) are common problems associated with aging. Despite the differences in diagnostic methods, a series of studies have appeared in recent years that have revealed a close relationship between sarcopenia and NAFLD. Sarcopenia and NAFLD are associated with a number of common pathogenetic mechanisms, which are discussed in the present article, including the role of insulin resistance at both the liver and muscle levels, hormonal imbalance, the role of systemic inflammation, dysregulation of myokines, vitamin D deficiency, the role of malnutrition and inactivity, the role of hepatokines and hyperammonemia, which indicates the bidirectional relationship between sarcopenia and NAFLD.

According to experts, sarcopenia, as a generalized progressive disorder of skeletal muscle function, will acquire the status of a global problem in the near future, which is associated with an increase in human life expectancy, and the significance of its main phenotypes (sarcopenic obesity, cachexia) is beyond doubt. The results of the meta-analysis indicate that sarcopenic obesity is a significant predictor of all-cause mortality among the elderly, especially hospitalized patients. Cachexia is a predictor of mortality in cancer. Of particular interest are the data on the close relationship between GERD and various phenotypes of sarcopenia. The presented review demonstrates the data available to date confirming this relationship. The importance of early diagnosis of sarcopenia, sarcopenic obesity and cachexia is shown in order to possibly correct this condition and reduce mortality rates. especially among the elderly.

Aim. To study the relationship between nocturnal blood pressure (BP) fall and kidney damage, the severity of obesity and markers of sympathetic activity in patients with type 2 diabetes mellitus (DM2) combined with resistant hypertension (HTN) depending on the accuracy of its assessment. Material and methods. The cross-sectional study included 64 patients with DM2 and resistant HTN, mean age 60.5±7.7 years (38 women), 24-hour BP (systolic/diastolic) (SBP/DBP) 155.9±16.7/81.4±12.7 mm Hg, HbA1c 7.3±1.5%. Patients underwent evaluation of free metanephrine, normetanephrine and lipocalin-2 levels in the blood, 24h urinary albumin excretion (UAE), 24h blood pressure monitoring and electrocardiography with assessment of heart rate variability (HRV) (low-frequency (LF) and high-frequency (HF) components). Nocturnal BP fall was determined using the standard (with a fixed sleep time interval of 23-7 h) and optimized methods (using a mathematical algorithm for detecting the nocturnal sleep period). Results. Significant correlations were found between the degree of nighttime decrease in SBP, calculated by the optimized method, but not by standard method, and HRV indices (r= -0.64, p<0.001 for LF; r=0.55 p=0.004 for HF; r= -0.65 p<0.001 for the LF/HF ratio), with the level of normetanephrines (r= -0.47, p=0.025), UAE (r= -0.47, p=0.008) and lipocalin-2 (r= -0.52, p=0.012). In patients with a body mass index (BMI)≥35 kg/m2, degree of nighttime decrease in SBP according to the optimized method was 2.5 times lower than in individuals with a BMI<35 kg/m2 (3.5±5.5 and 8.7±6.6%, respectively, p=0.003). Conclusion. In type 2 diabetic patients with resistant hypertension, the degree of nocturnal blood pressure fall calculated on the basis of objective determination of the time of night rest, in contrast to the standard method, is closely associated with markers of kidney damage, the severity of obesity, clinical and laboratory signs of sympathetic activity.

Introduction. When vibration disease (VS) and arterial hypertension (AH) are combined, disturbances in cellular-molecular interactions associated with increased concentrations of pro-inflammatory cytokines, oxidative stress, endothelial dysfunction, hormonal and metabolic disorders naturally lead to a transformation in the architecture of blood vessels, in addition to the risk of development and progression microcirculatory disorders with a combination of vibration disease and arterial hypertension is determined by gene polymorphisms. Target. Based on the study of clinical-functional, sanitary-hygienic and molecular-genetic indicators, develop additional diagnostic criteria for nutritional-metabolic disorders in vibration disease and arterial hypertension. Materials and methods. A single-center, open, non-randomized, cross-sectional study was conducted. The participants were divided into groups: 1st - patients diagnosed with stage I vibration disease. (n = 104); 2nd - patients diagnosed with hypertension stages I-II (n = 107); Group 3 - patients with similar parameters of the vibration disease and arterial hypertension groups (n = 101); 4th (control) - conditionally healthy individuals working at the same enterprise without contact with vibration and not having a diagnosis of hypertension (n = 119). Results. In the group of combinations of vibration disease and arterial hypertension, the body mass index corresponds to obesity grades 2 and 3. in 27.1%; 15.8%; whereas in the groups of only vibration disease and only arterial hypertension, obesity of the 1st degree predominates; a decrease in active cell mass and phase angle was recorded in the group with a combination of vibration disease and arterial hypertension compared to the control group by 1.4 and 1.3 times, respectively (p<0.001). In the group of vibration disease combined with arterial hypertension, the greatest increase of all study groups was found in the concentrations of oxidative stress indicators, MMP-1, MMP-9, neutrophil elastase, pentraxin 3, a decrease in parameters of the total antioxidant status of serum, the Cu/ZnSOD indicator, and an increase in pro-inflammatory cytokines IL -1β. In the same group, the frequency of occurrence of the T/T rs4880 genotype of the superoxide dismutase gene MnSOD was characteristic of oxidative stress, while carriage of the G/C rs20417 genotype of the COX2 cyclooxygenase gene did not affect the course of vibration disease combined with arterial hypertension. Conclusions. The combination of vibration disease and arterial hypertension occurs under conditions of nutritional and metabolic changes in conjunction with systemic inflammation, endothelial dysfunction, oxidative stress and an increased frequency of occurrence of the T/T nucleotide sequence variant of the Ala16Val locus (rs4880) of the MnSOD gene. The results of our own research based on the correlation and regression analysis made it possible to develop additional diagnostic criteria for nutritional and metabolic disorders in vibration disease combined with arterial hypertension.

This review presents current data on the pharmacokinetics, side effects, dosage forms and interactions of curcumin. Curcumin, the major bioactive component of turmeric, has low bioavailability due to its low water solubility, rapid metabolism in the liver and rapid excretion from the body. The main pathways of curcumin metabolism are described, including its reduction and subsequent conjugation with glucuronic acid and sulphates. Side effects of curcumin such as hyperoxaluria, iron deficiency anaemia, hepatotoxicity, arrhythmias, allergic reactions and potential carcinogenic properties are discussed. Various dosage forms of curcumin developed to enhance its bioavailability are discussed, including liposomes, nanoparticles, hydrogels and phytosomes. Particular attention is given to the drug interactions of curcumin with chemotherapeutic agents such as 5-fluorouracil, vincristine, gemcitabine, adriamycin and cisplatin, as well as with hypolipidaemic agents, antiaggregants and anticoagulants. These data highlight the need for further studies to optimise the therapeutic use of curcumin and minimise its side effects.

The gut microbiota can be regarded as a novel “metabolic organ,” involved in the regulation of metabolism. In the case of gut dysbiosis, changes in the concentration of certain bacterial metabolites can act as triggers for the development of metabolic and lipid metabolism disorders. For instance, lower levels of bacteria that produce short-chain fatty acids (SCFA), disorders of enterohepatic circulation of bile acids, elevated levels of trimethylamine (TMA)-producing gut bacteria play an important role in dyslipidemia. Undoubtedly, there are interactions between statin use and changes in the gut microbiota. The paper presents a analysis of the literature data and the results of own research concerning the effect of statins and probiotics on the lipid metabolism and on the microbiota. Considering the positive effects of some probiotics on lipid metabolism, their ability to counteract low-grade inflammation, immunomodulatory role and benefit influence on the digestive system, combining statins with specific probiotic agents appears to be a logical approach. Autoprobiotics (indigenous apathogenic benefit strains) are method of personalized therapy. They demonstrate promising results in the treatment of lipid metabolism disorders. We emphasize that autoprobiotics may be preferable over probiotics due to their safety and longer-lasting effect in the case of personalized therapy of lipid metabolism disorders. However, further research is warranted to gain a deeper understanding of the underlying mechanisms interaction of organism their microbiota including during statin, probiotic and autoprobiotic therapy patients with metabolic syndrome. in the influences and address remaining questions in this field.

In recent years, statistical studies show that cholelithiasis is detected in every fifth woman and every tenth man. Сholelithiasis is a multifactorial process that is influenced by both environmental and genetic factors. Some evidence suggests that total plasma homocysteine correlates with the presence of gallstones, suggesting that hyperhomocysteinemia is a risk factor for cholelithiasis. The aim of this work was to analyze the association of polymorphic variants of the methylenetetrahydrofolate reductase MTHFR (rs1801133 (677C>T), rs1801131 (1298A>C)) and methionine synthase reductase MTRR (rs1801394 (66A>G)) genes with the development of gallstone disease in individuals from the Republic of Bashkortostan. Material and methods. DNA samples from 196 patients with cholelithiasis and DNA samples from 274 individuals in the control group aged 23-87 years living in the Republic of Bashkortostan were used as research material. Genotyping was performed using the real-time PCR method. Results. It has been established that the rs1801133*T allele and the rs1801133*TT genotype of the MTHFR gene are markers of an increased risk of developing cholelithiasis. An association was established between the rs1801133*TT genotype of the rs1801133 polymorphic variant of the MTHFR gene and the moderate severity of cholelithiasis and hereditary burden in patients with cholelithiasis. A study of the polymorphic variant of the MTRR gene revealed that the rs1801394*G allele increases the risk of developing cholelithiasis. Analysis of associations of the polymorphic variant rs1801131 of the MTHFR gene with the development of cholelithiasis did not reveal statistically significant differences between the compared groups of patients and controls. Conclusion. Determination of homocysteine levels and genetic testing of polymorphic variants of MTHFR and MTRR in patients with cholelithiasis may be useful in clinical practice.

Care and treatment of children and adolescents with diabetes is an important part of the health care system. A socially oriented state is obliged to provide this category of patients with the development and application of the latest methods in the field of preventive diabetology and demography, and is obliged to form and educate the correct behavior of children and adolescents, which must be implemented in the family, school, and educational organizations. Direct training of patients/parents of sick children in the use of the latest algorithms for specialized medical care for patients with diabetes is of great importance. The article outlines the modern principles of organizing work in «Schools of Diabetes Mellitus» and «Schools of Health», existing educational programs designed not only to provide knowledge about the disease, but also to teach patients the skills of self-monitoring of the disease, the principles of independent decision-making on treatment and prevention. The role of medical workers and the achieved results in the field of teaching/prevention of exacerbations of diabetes mellitus in the union regime both in Russia and the Republic of Belarus are presented.

The article presents clinical cases of the use of virtual chromoscopy in the endoscopic diagnosis of colon neoplasms. The effectiveness of these methods and the specifics of their application in clinical practice have been evaluated.

Arteriovenous malformations (AVMs) are vascular pathologies in which tissue trophism and blood outflow are disrupted due to the congenital or acquired absence of capillaries and the formation of a single conglomerate in which the arteries pass directly into the veins. Aim: to share our experience in the diagnosis and treatment of AVM of the colon in children. Material and methods. Clinical case No. 1. A 4-year-old girl was admitted to the N.F. Filatov State Clinical Hospital with a clinical picture of gastrointestinal bleeding (GCC). For the first time, an episode of stool with streaks of blood was observed at 2 years and 4 months. The examination revealed ulcerative colitis in the rectum, multiple erosions covered with fibrin were found. Long-term conservative therapy with no effect. Upon admission to the clinic, the child’s condition is moderate, the stool is light brown, and there is dark blood on top of it in the amount of 3-4 drops. According to ultrasound data, a thickening of the walls of the rectum with a slight increase in blood flow in them is determined above the anus. During the radioisotope study, an increase in the accumulation of RFP in the lower abdominal cavity was revealed. CT scans of the abdominal cavity and pelvis with contrast indicate increased vascularization of the walls of the middle and lower third of the rectum. Ultrasound of the sigmoid and rectum was performed: at a distance of 40 mm from the anus, an area in the rectal wall was visualized in which blood flow was increased during CDK, and venous vessels with arterial pulsation in them were also detected there. Endovascular angiography was performed, and intestinal AVM was detected (in the venous phase, dilated pathological veins can be traced projectively to the ampoule of the rectum). Taking into account the intensity of bleeding (5-6 times a day), it was decided to remove the pathological part of the colon. Laparoscopic resection of the sigmoid and rectum according to Swanson was performed in two stages. During the first stage, during the revision and mobilization of the colon at the level of the superior sigmoid artery, a large number of dilated vessels were found in the mesentery, and pathological vessels were also detected along the posterior wall of the rectum. On 4-5 postoperative days, the bleeding resumed, which indicated the formation of collateral blood flow. On the 14th day after stabilization, the second stage of Swanson surgery was performed - a direct coloctal anastomosis was performed. The bleeding continued. A decision was made to disconnect the rectum and apply an ileostomy. However, in the postoperative period, abundant mucous discharge with a hemorrhagic component remained from the rectum. Repeated angiography was performed - the vessel feeding the AVM was identified and embolized - the volume of bleeding decreased, but it was not possible to completely stop it. A decision was made to perform a colectomy and form an ileoanal anastomosis. Intraoperatively, marked lymphorrhea, tortuosity, and vasodilation of the mesentery were noted during intestinal discharge. In the postoperative period, blood in the stool was observed in the form of rare veins, which eventually disappeared. Clinical case No. 2. A 10-year-old girl was admitted to the clinic complaining of blood in her stool. It is known from the medical history that for 2 years the child has been worried about periodic pain in the left side of the abdomen. A year ago, the first episode of blood in the stool. During the examination, the diagnosis of UAC was established - conservative therapy was prescribed, against which remission was noted for about 3 months. Further, the resumption of GCC was noted, despite the ongoing treatment. A radioisotope study was performed, and an increased accumulation of RFP was detected in the left abdominal cavity. Upon admission, the condition is of moderate severity, the child is malnourished. The abdomen is soft on palpation, moderately painful in the left abdomen. The stool is mushy, with an admixture of blood and mucus, a tendency to diarrhea. According to the results of angiography, AVM of the colon was detected: in the descending part of the colon and in the rectum, the pathological tortuosity of small arterioles with increased capillary blood flow was contrasted. To eliminate life-threatening bleeding, a left-sided hemicolectomy with the formation of a colostomy was performed. Intraoperatively, telangiectasia was detected along the anterior surface of the rectum, the vessels in the colon and the left half of the intestine were dilated to 4-5 mm. In the postoperative period, the child had minor bleeding from the distal rectum. Clinical remission was achieved within 1 year. Discussion. It is believed that AVM occurs in 1 in 10,000 people, while in the literature, the localization of AVM in the colon or small intestine is described in no more than a hundred observations, of which 80% of cases are localized in the left half of the colon or rectum. The most common symptoms of this pathology are GCC, accompanied by the development of iron deficiency anemia. It is worth noting that AVM of the large intestine is often hidden under the guise of inflammatory bowel diseases. Children have been receiving inappropriate therapy for years, which can be misdiagnosed as drug resistance. Conclusion. The diagnosis of AVM is established using imaging research methods. In case of accidental detection of AVM, wait-and-see tactics are used due to the high traumatic nature of surgical treatment. If symptoms are present, endoscopic laser or thermocoagulation, resection of the affected area, or endovascular treatment is possible.

Aluminum is a toxic metal for living systems. Aluminum accumulation is associated with damage to target organs: the liver and kidneys. The pollutant induces biochemical dysfunctions in the body, but the actual process is not fully understood. The purpose of the study was to evaluate metabolic changes in the liver and kidneys of laboratory animals after exposure to aluminum hydroxide in a subacute experiment. For 2 months, rats of three experimental groups received an aqueous solution of aluminum hydroxide daily orally in various doses. At the end of the experiment, the blood serum of experimental animals was used to conduct biochemical studies. The activity of aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase was determined; content of total protein, albumin; levels of uric acid, urea and creatinine. It was found that subacute exposure to aluminum hydroxide in various doses significantly increased disturbances in the liver and kidneys of experimental animals, with concomitant changes in the level of indicator enzymes and metabolites. The toxic effects of aluminum are due to the formation of reactive oxygen species and the generation of free radicals. The accumulation of aluminum in the liver of experimental animals leads to damage to hepatocellular cells and the bile duct. Increased production of free radicals, along with decreased excretory capacity of the nephrons, contributes to functional changes in the kidneys.

Introduction. Porphyrias are a group of metabolic diseases caused by hereditary defects in the enzymatic system of heme biosynthesis. According to the modern classification porphyrias are considered independent diseases, which are caused by specific enzymatic defects, resulting in certain disorders of porphyrin metabolism and peculiarities of the clinical course of the disease. Acute intermittent porphyria (AIP) occupies a special position in the group of hepatic porphyrias by its biochemical and clinical features and unfavorable prognosis. Materials and Methods. We present a brief review of the literature on the problem of AIP and our own clinical case report. А 49-year-old female patient P. with type 2 diabetes mellitus, was followed by internists, endocrinologists, neurologists for about 8-10 years. She was repeatedly hospitalized in specialized departments and underwent complex examination. Results. During the follow-up the patient experienced increasing abdominal pain and numbness in the upper and lower extremities, and gait disturbance. Pink-colored urine was observed. A porphyrin metabolism disorder was suggested. Verification of AIP was performed by quantitative determination of the excretory profile of porphyrins. Elevation of porphyrin precursors (δ-aminolevulinic acid and porphobilinogen) are the main criteria for confirming diagnosis. Conclusion. When analyzing the cause of AIP manifestation, it was found that due to concomitant pathologies the patient has been exposed to a number of drugs with porphyrinogenic effect. In addition, the symptoms of AIP were probably masked by manifestations of diabetic gastropathy and polyneuropathy.

A clinical case of an extremely rare morphologically verified combination of primary biliary cholangitis and hemochromatosis in a patient is presented. A brief description and literature reference on these diseases are given from the standpoint of a modern approach to diagnostics, classification, clinical manifestations and treatment. The presented observation considers the course of the disease in a patient from the onset to the present time, including the stage of self-induced cessation of taking the necessary medications and seeking medical help, which led to rapid progression of the disease with pronounced clinical manifestations with the appearance of a typical color of the skin, the appearance of xanthelasma, hepatosplenomegaly and hepatocellular insufficiency. The data of laboratory and instrumental examination conducted in various clinics are analyzed. It is important to note that liver cirrhosis as a result of primary biliary cholangitis and hemochromatosis has a very unfavorable prognosis, and the treatment is comprehensive.

Objective: To present a case of chronic diarrhea as an atypical manifestation of primary adrenal insufficiency in a young man. Main points: Diagnosis of primary adrenal insufficiency (AI) can take a long time due to diverse and uncharacteristic initial symptoms. Diarrhea is not a typical manifestation of AI and therefore can be mistakenly considered infectious or as a manifestation of irritable bowel syndrome even in patients with an established diagnosis of AI. We present a case of chronic diarrhea (more than 6 months) in a young man with primary AI, which developed due to unsatisfactory therapy of the underlying disease. After correction of hypocorticism diarrhea completely resolved. Conclusion: The diagnosis of AI can be delayed in primary patients, and AI can be underestimated in patients with an established diagnosis too. Chronic diarrhea is one of the symptoms of AI and clinicians should consider this in the differential diagnosis of patients corresponding to the clinical picture of this disease. Repetitive patient education on methods of controlling AI is very important, including adjusting the dosage of steroid medication in case of medical interventions, injuries and infections.

The article presents data on the origin of the Russian names of the structures of digestive system: pharynx, esophagus, stomach, intestine (including its parts).

The article is devoted to the life and work of the outstanding surgeon, scientist and teacher Vasily Nikolaevich Parin (1877-1947). It tells about his life path, starting from being born into a poor craftsman’s family and studying at Kazan University, and ending with a significant contribution to the development of surgery and the creation of a medical institute in Izhevsk. The article highlights the versatility of the personality of V.N. Parin, who was not only a talented surgeon, but also a scientist, teacher, organizer and public figure. The article also mentions V.N. Parin’s son, Boris Vasilyevich, who also connected his life with medicine and became the organizer of the blood service in Udmurtia.