This review presents current laboratory and instrumental methods for cardiovascular toxicity diagnosing in patients with multiple myeloma undergoing autologous hematopoietic stem cell transplantation. In the absence of national guidelines on the timing and frequency of monitoring, it is particularly important to have a set of techniques to detect preclinical stages of myocardial dysfunction. The most useful methods include transthoracic echocardiography, with assessment of global longitudinal strain using speckle tracking, and measurement of cardiac biomarkers such as troponin T and I, and natriuretic peptides. Using this combination of methods allows for early detection of cardiotoxicity, which is essential for timely intervention and treatment.

Nowadays, the problem of antimicrobial resistance of some representatives of Gram-positive bacteria is one of the global threats to public health. More than 30 % of the population is asymptomatic carriage of S. aureus on the surface of the epithelium and mucous membranes, in 60 % of cases, its transient carriage is determined. The problem lies not only in the ubiquity and high frequency of isolation of Staphylococcus aureus, but also in the increasing level of drug resistance of this species. The aim of this scientific article is to conduct a comprehensive analysis of the mechanisms of Staphylococcus aureus resistance to modern antibacterial drugs, taking into account the wide spread of resistant forms of this pathogen. The materials and methods of the study were literature reviews of recent advances in the study of the molecular basis of resistance and interaction of Staphylococcus aureus with different classes of antibiotics, such as β-lactams, glycopeptides, fluoroquinolones, as well as new approaches to the creation of effective therapeutic strategies. Results. The main results of the review indicate the diversity of mechanisms utilized by S. aureus to resist antibiotics. Among them, the ability to produce β-lactamases, degradation of peptidoglycan structure and adaptation of cellular metabolism to minimize the impact of antibacterial agents are highlighted. The article highlights the importance of combining antibiotics from different groups, such as β-lactams and glycopeptides, to minimize the risk of resistance development. Conclusion. The conclusion emphasizes the need to further explore cell division pathways, nucleic acid synthesis and peptidoglycan synthesis as possible application points for future antibacterial drugs. Special attention is given to new directions such as the study of inhibitors of fatty acid biosynthesis and the FtsZ protein, which plays a key role in cell division. Thus, this work offers a deep understanding of the molecular processes underlying S. aureus resistance and forms the basis for further development of innovative approaches to the therapy of staphylococcal infections.

Recently, there has been an increase in the number of hospitalizations of patients with chronic renal insufficiency, along with a steady general increase in the number of patients undergoing programmed hemodialysis. In addition, acute pancreatitis often remains the leading diagnosis during hospitalization, but there is no consensus on diagnostic and therapeutic measures for this group of patients. The data on adverse outcomes and complications from surgical interventions in patients undergoing hemodialysis are also disappointing. A comprehensive diagnostic approach, taking into account medical history, clinical and laboratory data, and instrumental studies, makes it possible to differentiate the form of acute pancreatitis and choose a rational treatment strategy. At the same time, the lack of uniform diagnostic criteria leads clinicians to search for optimal clinical and laboratory data in the stratification of forms of acute pancreatitis in patients undergoing programmed hemodialysis. A comprehensive assessment of the severity of acute pancreatitis against the background of comorbid renal pathology provides reliable diagnostic data.

Chronic lymphocytic leukemia, being the most common type of leukemia in adults, is common in the elderly, which increases the likelihood of comorbid conditions that can significantly affect the tolerability of therapy, the quality of life of patients and survival. Objective. A review of the current literature on the impact of comorbid pathology on treatment outcomes in patients with chronic lymphocytic leukemia, as well as an assessment of the interaction between these conditions. Materials and methods. The analysis was conducted based on existing studies in the PubMed database. The following English language search terms were used: “chronic lymphocytic leukemia” in titles, abstracts and keywords in combination with the following search queries: “comorbid conditions”, “survival”, “clinical outcomes”, “quality of life”, “elderly patients”. The search and selection of literature sources was performed from September to December 2024. Various comorbid diseases and their impact on prognosis, survival, overall health status, and quality of life in patients with chronic lymphocytic leukemia. Results. The literature review emphasizes the critical importance of considering comorbidities in the diagnostic and therapeutic process. Chronic lymphocytic leukemia, being the most common type of leukemia in adults, frequently occurs in older individuals, increasing the likelihood of comorbid conditions that can significantly influence survival, treatment tolerability, and patients' quality of life. Numerous studies confirm that the presence of comorbidities such as cardiovascular diseases and diabetes adversely affects clinical outcomes. This underscores the necessity of a multidisciplinary approach to managing this category of patients, involving not only hematologists but also cardiologists and endocrinologists. Modern therapeutic methods, including targeted and immunotherapeutic approaches, demonstrate promising results; however, their application requires careful assessment of the patient's functional status and potential comorbidities. The emergence of new drugs also provides patients with the option to choose more comfortable and less toxic treatment alternatives, which can potentially enhance their quality of life. Conclusion. Further research is needed to deepen the understanding of the interactions between chronic lymphocytic leukemia and comorbid conditions and to develop more precise management recommendations tailored to individual patient characteristics. Successful treatment should not be limited to clinical outcomes but also encompass aspects of quality of life, which is an essential priority in contemporary oncology.

The gene system of enzymes of xenobiotic metabolism plays an important role in the metabolism of many substances entering the human body. According to the available scientific research, a certain amount of information has accumulated on the study of polymorphic variants of genes for xenobiotic biotransformation enzymes in bronchopulmonary pathology, in particular pulmonary tuberculosis. The aim of the study was to identify the relationship between the genotype of the xenobiotic biotransformation enzyme (GSTM1) in patients with pulmonary tuberculosis and the effectiveness of the intensive phase of chemotherapy. Material and methods. The research includes an analysis of modern literature, the development and formulation of goals and objectives of the work, the design of the scientific work carried out, the collection, processing and analysis of the results, the formulation of conclusions and practical recommendations. To solve these tasks, we analyzed the clinical, laboratory and instrumental data of 335 patients with pulmonary tuberculosis aged 18 to 65 years receiving intensive chemotherapy, including 212 patients with newly diagnosed and 123 people with chronic pulmonary tuberculosis. Associations of alleles and genotypes with predisposition to pulmonary tuberculosis were assessed using the odds ratio. Results of the study. The study revealed that in patients with newly diagnosed pulmonary tuberculosis, scarring of the decay cavities is 2,9 times more often associated with the genotype of its GSTM1 gene, while in patients with chronic pulmonary tuberculosis it is 2,4 times more often compared with the DD genotype of the GSTM1 gene (p < 0.001). A decrease in lung tissue infiltration is 5,3 times more often associated with the genotype of its GSTM1 gene in patients with newly diagnosed pulmonary tuberculosis, while in patients with chronic pulmonary tuberculosis it is 1,7 times more often compared with the DD genotype of the GSTM1 gene (p < 0,001). Conclusion. The genotype of GSTM1 gene is an independent predictor of the most favorable course of tuberculosis infection, while the DD genotype of the GSTM1 gene is associated with the most unfavorable course of this infection.

Information on the morphology of the auricle and the relationship between individual anatomical structures of the human body and the structure of the auricle is very limited. Most authors acknowledge the existence of gender differences. However, there are studies indicating that anthropometric indicators are not strictly determined by gender.

The aim of the study. To determine the morphometric parameters of the auricle in adolescence, their gender differentiation and to search for the relationship between the structure of the auricle and the shape of the head.

Materials and methods. The authors proposed a research method based on photographic images of the auricle. The study used 201 photographs of the right auricle of boys and girls with the same head shape. The topographic position of individual ear structures was determined. A comparison of the obtained indicators was made between dolichocephalic boys and girls.

Results. The values of the position of individual structures of the auricle of girls and boys with the same head shape and one age group were determined. Gender differences were confirmed.

Conclusions. The obtained results demonstrate statistically reliable gender differences in almost all studied parameters of the auricle of dolichocephalic boys and girls. The position of the apex of the tragus and the bottom of the intertragal notch are interconnected regardless of gender. In boys, the coordinates of the apex of the tragus correlate with the position of the anterior edge of the helix.

Evaluation of a relationship of extrasystole with human chorionic gonadotropin is one of the poorly studied issues of obstetrics and cardiology.

A purpose of this work is to study an effect of human chorionic gonadotropin on course of extrasystolic arrhythmia in the first four weeks of pregnancy.

Material and methods. Dynamic observation was carried out for four weeks in 36 pregnant women with symptomatic ventricular extrasystole (group 1) and 24 pregnant women with asymptomatic extrasystole (group 2). Patients are examined weekly in the absence of therapy. Research methods include ECG registration, cardiac ultrasound, 24-h ECG monitoring, determination of human chorionic gonadotropin, TSH, T4(f).

Results. It is found that an increase in a duration of pregnancy leads to an increase in the number of symptomatic extrasystoles (p < 0.05) and a decrease in the number of asymptomatic ones (p < 0.05). A correlation dependence (p < 0.05) of human chorionic gonadotropin with TSH was shown at the 1^st, 2^nd, 3^rd and 4^th weeks of pregnancy and human chorionic gonadotropin with extrasystole at the 4^th week. A threshold value of human chorionic gonadotropin is revealed, indicating an increase in amount of extrasystole.

Conclusion. With increasing gestational age, the number of symptomatic extra systoles increases. Human chorionic gonadotropin plays an important role in arrhythmogenesis during gestation.

A serious global problem of the 21st century is the fight against bacterial infections caused by microorganisms with multiple drug resistance. Scientists are constantly searching for new therapeutic agents active against antibiotic-resistant strains. Secondary metabolites of microbial origin have historically proven their importance as a source of valuable compounds with antimicrobial activity. The genus Corynebacterium spp., which has recently attracted the attention of scientists due to the discovery of individual species with probiotic potential, has not been previously studied in this aspect.

Purpose of the study: to study the antimicrobial and antibiofilm activity of extracts of vaginal isolates of Corynebacterium amycolatum.

Material and methods. The material for the study were extracts of three vaginal isolates of C. amycolatum ICIS 5, ICIS 9 and ICIS 53. The antimicrobial activity of the extracts was studied in vitro against 4 test strains of pathogenic microorganisms using the paper disk method. The effect of the extracts on pre-formed biofilms of the test strains was studied in 96-well polystyrene plates. The morphology of the test strain biofilms after pre-treatment with C. amycolatum extracts was studied using scanning electron microscopy. The experimental data were processed using variation statistics methods with the calculation of the arithmetic mean and its error (M±m) from 3 measurements.

Research results. The antibacterial and antibiofilm activity of all tested C. amycolatum extracts was established against Klebsiella pneumoniae ATCC 13883, Pseudomonas aeruginosa ATCC 27853, Staphylococcus aureus ATCC 25923 and Enterococcus faecium ATCC 19434. The severity of antibacterial activity and the degree of destruction of the formed biofilm depended on the type of the tested microorganism. Scanning electron microscopy studies revealed a flat, scattered and unstructured architecture of the biofilms of the test strains.

Conclusion. The data obtained open the prospect of studying the metabolic profile of C. amycolatum extracts to understand the nature and mechanism of the detected antibacterial and antibiofilm activity.

Today, the urgent task is to identify predictors of such fatal complications as cardiogenic shock, pulmonary edema, cardiac rupture, asystole in patients with myocardial infarction. It is known that the development of the above complications is to a certain extent associated with the localization of myocardial infarction.

The aim is to identify constitutional features in men who died from acute myocardial infarction of different localization.

Materials and methods. An anthropometric study of 82 corpses of men of the second period of adulthood (36–60 years old) who died of myocardial infarction of various localization was conducted. After measurement, the body types of the corpses were determined by V. N. Shevkunenko, L. Rees H. J. Eisenk, V. M. Chernorutsky, J. Tanner, the shape of the abdomen by V. M. Zhukov, body weight – according to A. Quetelet and body density – according to H. Rohrer. The data obtained was entered into the MS Excel 12.0 program (Microsoft Corporation) and the analysis of the generated data was carried out using the Statistica for Windows 12.0 program. The mean, mean error, and standard deviation were estimated, and the difference (at p < 0.05) between the fractions was calculated using the Pearsons x2 criterion.

Results. The study revealed that in men who died from myocardial infarction, in 56.1 % of cases, the necrosis focus was localized in the anterior wall of the heart, in 25.6 % – the posterior, in 7.2 % – the lateral, in 3.7% – the upper, in 1.2 % – the lower, and in 6.2 % – the interventricular septum. The predominant (60 %) anterior localization of necrosis in the heart was revealed in men who died from acute myocardial infarction, and in case of repeated myocardial infarction – anterior (48.1 %) and posterior (40.8 %). When using the somatotyping technique according to L. Rees, H. J. Eisenk found that among men who died from myocardial infarction of anterior localization of necrosis, persons of normosthenic physique are significantly 3 times less common, but 6 times more common than asthenic ones. For men with posterior localization of myocardial infarction, the opposite ratio is characteristic, namely, persons of normosthenic physique are 3 times more common and 6 times less common than asthenic ones.

Conclusion. Men who died from myocardial infarction with anterior localization of necrosis are more likely to have an asthenic (according to the classification of L. Rees, H. J. Eisenk) body type, and with a posterior – normosthenic.

A gunshot wound is the most complex type of "acute" wound both in morphological and pathophysiological aspects, and in the efforts made to treat it. Studies of chitosan as a material for wound treatment are relevant, despite the large number of publications, due to its properties (bioinertness, biodegradability, hydrophilicity, antimicrobial and pro-regenerative activity).

Objective. To determine the efficiency of hydrophilic chitosan sponge with enzymatic activity in treatment of gunshot wounds.

Materials and methods. Patients with gunshot wounds of soft tissues of the extremities requiring local treatment were randomly divided into two groups. Patients of the main group (n = 25) used dressings based on chitosan sponge with chymotrypsin. Patients of the control group (n = 23) used gauze dressings with chymotrypsin lyophilisate and levomekol ointment. During treatment, planimetric, volumetric, thermometric measurements were performed, morphological characteristics of the wound were recorded, microscopic examination of smears-imprints from the wound was performed.

Results. In the first phase of the wound healing process, statistically significantly higher rates of wound healing were noted in the main group than in the control group (area decrease of 5.2 ± 2.1 % per day in the main group, area decrease of 3.8 ± 2.4 % per day in the control group, p ≤ 0.05). A significantly higher number of cases of change in the type of wound smear-imprint cytogram in the first phase of the wound healing process towards the regenerative type in the main group was revealed (p ≤ 0.05). A statistically significant difference was noted in the increase in the rate of change in the relative temperature of the wound in the first phase of the wound healing process (0.5 ± 0.7℃ per day in the main group, 0.0 ± 0.5℃ per day in the control group, p ≤ 0.01), which may indicate a decrease in the time of wound cleansing and tissue regeneration in the main group.

Conclusion. Chitosan sponge with enzymatic activity when used as a wound covering for gunshot wounds in the first phase of the wound healing process helps to reduce the time of wound cleansing and tissue regeneration in comparison with lyophilized chymotrypsin and Levomekol ointment based on a gauze bandage.

One of the leading causes of impaired implantation of the fetal egg is chronic endometritis. Currently, microbial-viral associations play an increasingly important role in the genesis of chronic endometritis. The aim of the study was to evaluate the effectiveness of combined immunomodulatory sanitation at the stage of pre-pregnancy preparation in women with chronic endometritis who have a history of abortion in the first trimester or failure of assisted reproductive technologies.

The aim of the study was to evaluate the effectiveness of combined immunomodulatory sanitation at the stage of pre-pregnancy preparation in women with chronic endometritis who have a history of abortion in the first trimester or failure of assisted reproductive technologies.

Materials and methods. A comparative bacteriological and morphological analysis of the metroaspirate and the flora of the cervical canal before and after treatment was performed. In 67.2 % of cases, cultural studies of metroaspirate did not reveal a significant concentration of the etiological agent. At the same time, both viral (31.2 %), bacterial (20.3 %), and viral-bacterial associations (48.4 %) were identified in all subjects from the cervical canal. At the first stage, all patients were prescribed antibacterial therapy within 14 days, according to the revealed sensitivity. To eliminate the viral lesion or reduce the viral load, an antiviral agent of the nucleoside analog group was used in combination with local vaginal sanitation. In the main group, a combined drug (interferon alpha-2b human recombinant 50 thousand mg) was used for 10 days. IU + metronidazole 250 mg + fluconazole 150 mg), in the comparison group dequalinium chloride 10 mg for 6 days. At the 2^nd stage of complex therapy, identical methods of rehabilitation of patients with chronic endometritis were used in both groups, in the form of prescribing phase-by-phase hormone therapy and physiotherapy.

Results. The effectiveness of treatment was assessed 3 months after the end of treatment based on the elimination (or reduction of the quantitative load) of the pathogen and restoration of the morphological structure of the endometrium. In 30 patients of the main group (88.2 %), there was a decrease in the detection rate of lymphoid infiltrates and plasma cells in endometrial tissue compared to 22 patients (73.3%) from the comparison group (p < 0.05). It was noted that in these patients, the titers of microflora were within the reference values with a predominance of Lactobacillus spp.

Conclusion. The use of interferon alpha-2b as part of combined rehabilitation therapy had a synergistic effect and improved the decontamination effect in mixed bacterial and viral infections of both the cervical canal and the endometrium.

Acute pancreatitis remains an unsolved problem of abdominal urgent surgery. Therefore, there remains a need for a deep study of the etiology and pathogenesis of acute pancreatitis, including on the basis of modeling acute pancreatitis in the experiment.

The purpose of the study: to conduct a comparative assessment of the quality of acute pancreatitis models by changes in the concentration of enzymes and C-reactive protein in the blood of rats.

Materials and methods. Acute pancreatitis was modeled in an experiment on 20 outbred white laboratory male rats by subcapsular administration of the nonionic detergent Triton X-100, the anionic detergent sodium dodecyl sulfate, or the cationic detergent cetylpyridinium chloride. A similar operation was performed in the control group, but instead of the detergent solution, the animals were administered a physiological solution. On days 1, 5, 9, and 14 from the moment of modeling acute pancreatitis, the activity of alanine aminotransferase, aspartate aminotransferase, alpha-amylase, and Creactive protein was determined in the blood serum of the animals.

Results. It was found that 5 % concentrations of Triton, sodium dodecyl sulfate and cetylpyridinium chloride used to model pancreatitis caused the development of acute aseptic pancreatitis in rats, which was absent in the control group of rats, which was confirmed by the results of studying the dynamics of alanine aminotransferase, aspartate aminotransferase, alpha-amylase and C-reactive protein levels in rat blood serum in all three models. When pairwise comparing groups of rats with different models of acute aseptic pancreatitis, statistically significant differences between the models were not found. However, according to our observations, the model of pancreatitis induced by sodium dodecyl sulfate should be given priority, as it is forty times less toxic than cetylpyridinium chloride.

Conclusion. The study confirmed the importance of developing new models for simulating acute pancreatitis. The models used in the study ensured 100 % survival of the experimental animals, and the selected biochemical parameters confirmed the development of acute aseptic pancreatites in all experimental groups. The results of the study may be useful in studying new drugs for the treatment of pancreatitis.

The purity of testing of implants and medical equipment depends on the creation of an experimental model.

The purpose of the study: to create a chronic model of a median hernia for testing various implants or surgical techniques.

Material and methods. 23 female pigs weighing 15-20 kg underwent surgery to induce a postoperative hernia model. 2 groups were identified. To create a low-traumatic hernia model, an endoscopic stand manufactured by Kazan, an optical trocar VISIPORT 5-12 mm AutoSuture with a laparoscope were used. To test the biological implant, an autocutaneous skin was chosen (Russian patent for the invention No. 2022103233 / 09.02.2022). A hardware device (exhaust mechanism) was also tested (Russian patent for the invention No. 2022131316 / 28.07.2023).

Results. After 30 days in both groups, diastasis corresponded to hernia W3. In the first group (main 12 individuals), it averaged 13.14 ± 1.33 cm (M ± m). The hernia gate area ranged in both groups from 296.53 ± 43.32 to 666.6666 square centimeters. In the second group (11 individuals), diastasis corresponded to an average of 14.34 ± 1.33 cm (M ± m) with an area of 296.53 ± 43.32. There was no mortality in both groups. When analyzing the results during the first week, the 1st animal had a complete eventration in the lower corner of the wound, which was sutured. In three animals, suppuration of the wound with the opening of the abscesses. During the second week, one animal of the second group had local suppuration near the cutting ligature, and in three animals in which abscesses were opened, infiltrates were detected in the projection of the postoperative scar. During the third and fourth week, the presence of infiltrate in the projection of postoperative was recorded in these three animals. At the second stage of the experiment, chronic abscesses were found in these three animals before herniation after cutting out the skin flap. There were no complications in the first group.

Conclusion. The created chronic model of a minimally invasive hernia has all the elements of a W3 postoperative hernia, has fewer postoperative complications in the area of its formation, which contributes to a more favorable condition for testing implants and surgical techniques.

Chronic pyelonephritis is a nonspecific inflammatory process of predominantly bacterial nature, especially dangerous for elderly patients at risk. The monocytogram allows you to evaluate and compare the percentage of monocytes of different classes in peripheral blood in healthy people and patients with diagnosed pyelonephritis of different age groups, which can be used as an additional method of its diagnosis.

The research objective: to study the monocytogram and the values of monocyte indices of peripheral blood in elderly patients with chronic pyelonephritis.

Materials and research methods. Peripheral blood samples from healthy individuals and patients of three age groups with chronic pyelonephritis in the exacerbation stage were studied: 1 group – 18–44 years old, 2 group – 45–59 years old, 3 group – 60–74 years old. The monocytogram was studied, the blood leukocyte shift index, leukocyte intoxication index, neutrophil and monocyte ratio index, and lymphocyte and monocyte ratio index were calculated.

Research results. The absolute number of class 1 monocytes in the group of young and elderly patients is increased compared to the control (p < 0.05). The relative number of class 1 monocytes in all age groups does not change compared to healthy people. The absolute number of class 2 monocytes is higher in groups 1 and 3 compared to the group of healthy people (p < 0.05). The number of class 2 monocytes is increased in the group of young patients compared to the control (p < 0.05). The absolute number of class 3 monocytes is higher in groups 1 and 3 compared to healthy people and patients of group 2 (p < 0.05). The percentage of class 3 monocytes is lower in groups 1 and 2 compared to the control and patients of group 3 (p < 0.05). The shift index of blood leukocytes in the group of the elderly is higher than in the control (p < 0.05). The leukocyte intoxication index is higher than in the control in elderly patients (p < 0.05). The neutrophil to monocyte ratio is reduced in the group of young patients relative to the group of elderly patients (p < 0.05). The lymphocyte to monocyte ratio is reduced in all age groups relative to the control (p < 0.05).

Conclusion. Changes in monocyte indices reflect an increase in the proliferation of monocyte precursors in the bone marrow with an accelerated release of younger forms into the blood, indicate a decrease in the reactivity of the blood defense system in elderly patients with chronic pyelonephritis, along with a pronounced reaction of the monocyte-macrophage system in elderly and young patients. Integral indicators of the peripheral blood leukocytogram reflect the work of the effector mechanisms of the immune system, they indicate the preservation of protective compensatory-adaptive mechanisms in elderly people and a pronounced blood reaction to inflammation in a group of elderly patients with chronic pyelonephritis.

One of the most common pathologies of the thyroid gland is goiter. This is a persistent enlargement of the thyroid parenchyma, more often located in the neck area. However, in rare cases, cervical-substernal goiter occurs, in which the lower poles of the thyroid gland fall below the jugular notch of the sternum into the anterior, or, less often, into the posterior mediastinum. In the structure of morbidity, retrosternal goiter accounts for 30% of all benign neoplasms of the mediastinum, more common in women over 65 years of age. Surgical intervention is the only radical method of treating cervical-substernal goiter. Often, pathologically altered thyroid tissue lies deep in the mediastinum, as a result of which surgical interventions in such patients are operations of particular complexity. Some authors prefer only cervical access during surgical treatment of substernal goiter. However, at present, the need for combined cervicalsternotomy access in patients with retrosternal goiter is increasingly becoming apparent in clinical practice. An important role in choosing this surgical access is played not so much by the size of the cervical-substernal goiter, as by its ratio to the surrounding anatomical formations. In the presented clinical case, patient K., 73 years old, had a tumor in the anterior mediastinum on computed tomography. After a comprehensive examination, a chest goiter was diagnosed, and a multidisciplinary consultation developed treatment tactics. A team of oncological surgeons, together with a cardiovascular surgeon, performed an operation to remove the goiter using a combined cervical-sternotomy approach. After successful separation from the main venous vessel and pericardium, the goiter was successfully resected. The correct choice of operative access and the possibility of integration into the operating team of specialists in related fields of medicine determines the optimal amount of treatment and its long-term results.