RENAL INVOLVEMENT IN PRIMARY SJOGREN’S SYNDROME (CASE REPORT)

This article presents a clinical case of primary Sjogren's syndrome with a detailed description of the clinical and laboratory dynamics of the disease and its extraglandular manifestations based on the analysis of the data obtained during the patient's hospitalizations in the rheumatology department of the Grodno University Clinic in the period from March 2018 to June 2021.

EFFECTS OF NEW PIPERIDINE DERIVATIVES WITH SUBSTITUTIONS IN THE 1ST AND 4TH POSITIONS IN NALOXONE SENSITIVE ANALGESY

Background. Despite the wide arsenal of painkillers, pain relief is an urgent interdisciplinary problem that requires a search for new solutions. Purpose of the study. To establish the role of opioid receptors in the mechanism of the analgesic action of the piperidine derivatives AGV-22 and AGV-23. Material and methods. The studies were carried out on 96 white mice of both sexes weighing 30-40 g. The analgesic effect of the compounds was tested on models of thermal and chemical irritation with preliminary administration of the opioid receptor antagonist naloxone. Results. The pain reactions of mice with models of thermal and chemical stimulation in the AGV-22 / AGV-23 + naloxone and AGV-22 / AGV-23 groups were comparable. Conclusions. The mechanism of the analgesic action of the piperidine derivatives AGV-22 and AGV-23 is not associated with the activation of opioid receptors.

CASE OF SECONDARY THROMBOTIC THROMBOCYTOPENIC PURPURA TRIGGERED BY COVID-19

The article analyzes a clinical case of the development of thrombotic thrombocytopenic purpura (TTP) in a patient with verified COVID-19 infection. The algorithm of TTP diagnosis when ADAMTS13 biomarker test is unavailable is presented. The article presents the scheme of effective treatment of TTP with the use of plasma exchange, methylprednisolone and rituximab administration.

THE EFFECT OF N-ACETYLCYSTEINE AND DEXAMETHASONE PARENTERAL ADMINISTRATION ON THE BIOCHEMICAL PROCESSES IN THE AQUEOUS HUMOR OF THE ANTERIOR CHAMBER OF THE EYES IN RABBITS WITH EXPERIMENTAL IMMUNOGENIC UVEITIS

Objective. To evaluate the impact and compare the efficiency of parenteral administration of N-acetylcysteine (NAC) and dexamethasone when used as monotherapy or combination therapy in the treatment of experimental immunogenic uveitis (EIU) in rabbits, as well as to explore the changes of biochemical parameters in the aqueous humor of the eyes in experimental animals. Material and Methods. An experimental study was performed on 45 rabbits (90 eyes). Of these 5 healthy intact rabbits (10 eyes) served as a control group. Acute immunogenic uveitis was caused in 40 rabbits by injecting normal horse serum subcutaneously (5 ml) and then intravitreally (0.07 ml). The animals with experimental uveitis were divided into 8 groups (5 animals each). The first 4 groups – control-1, experiment-1, control-3, experiment-3 – received daily intramuscular injections of placebo, NAC, dexamethasone or a combination of NAC and dexamethasone respectively for 3 days, and thereafter they were withdrawn from the experiment. The remaining 4 groups – control-2, experiment-2, control-4, experiment-4 received, respectively, daily intramuscular injections of placebo, NAC, dexamethasone, a combination of NAC and dexamethasone for 7 days, and after that they were also withdrawn from the experiment. The drugs in the aforementioned groups were used from the moment of the horse serum intravitreal injection. When withdrawing animals from the experiment, aqueous humor was taken from the anterior chamber of their eyes, followed by the evaluation of protein (albumin) concentration and the number of leukocytes. Results. A significant elevation of albumin and the number of leukocytes in the aqueous humor of the eyes in the rabbits with experimental immunogenic uveitis was noted. NAC effectively reduced the level of albumin and the number of leukocytes in the aqueous humor. Dexamethasone showed more efficacy in reducing the investigated aqueous humor biochemichal parameters than NAC. Nevertheless, a synergism of the pharmacological action of NAC and dexamethasone was detected, since their combination had the greatest potency in reduction of albumin level and the number of leukocytes in the aqueous humor of the eyes in the rabbits with experimental immunogenic uveitis, even though the dosage of dexamethasone in the groups with combined (NAC and dexamethasone) therapy was reduced by 50% (1 mg / kg body weight). Conclusion. Parenteral administration of NAC significantly reduces inflammation in EIU. Combination of NAC and dexamethasone showed synergy of action in reducing the intensity of inflammatory process in rabbits with EIU, which is an objective rationale for including NAC in the complex therapy of uveitis, which in turn will reduce a single or course dose of dexamethasone and lower the risks of side effects caused by glucocorticoids.

PREDICTORS OF THERAPEUTIC RESPONSE AND LENGTH OF HOSPITALIZATION IN PATIENTS WITH SCHIZOPHRENIA DURING PHARMACOTHERAPY

Topicality. Search for scientifically based criteria for symptomatic remission and outcomes in schizophrenia is an urgent problem in modern psychiatry. Aim. To determine predictors of therapeutic response and duration of hospitalization during the course of psychopharmacotherapy in patients with schizophrenia. Material and methods. Clinical and metric examination using scales for assessing severity of positive (SAPS, PSYRATS, BABS) and negative (SANS, NSA-5) symptoms was performed in 157 patients with a diagnosis of schizophrenia twice: on admission to hospital and after the course of psychopharmacotherapy. The model for predicting therapeutic response was built using logistic regression, the model for predicting duration of hospitalization was built using linear regression using metrically justified criteria for achieving a significantly low level of severity of positive and negative symptoms as criteria for a significant therapeutic response. Results. The predictors were determined that increase and decrease likelihood of therapeutic response for scales for assessing positive and negative symptoms in patients with schizophrenia during the course of psychopharmacotherapy. Conclusions. Therapeutic response prediction models for scales for assessing the severity of positive symptoms and scales for the severity of negative symptoms are of good quality and high diagnostic value.

FEATURES OF DIAGNOSIS AND TREATMENT OF ILIOPSOITIS IN A PATIENT WITH DIABETES MELLITUS. CLINICAL CASE

A clinical case of iliopsoitis detected during hospitalization in the endocrinology department of the Healthcare Institution "Grodno University Clinic" is presented. The article describes the tactics of examination and successful treatment of iliopsoitis in a patient with diabetes mellitus and SARS-CoV-2.

CLINICAL AND EPIDEMIOLOGICAL FEATURES OF OVARIAN NEOPLASMS IN GRODNO REGION

Background. When providing specialized medical care and planning preventive measures, analysis of epidemiological data is instrumental in determining what should be done to reduce morbidity and mortality from ovarian malignant neoplasms (OMNs) within the given scenario. Purpose of research. To study the epidemiological situation with OMNs in the Grodno region. Material and methods. The OMN incidence and indicators of the quality of oncological care in the Grodno region were analyzed according to the data obtained from the Belarusian cancer registry. Results. Since 2007, the OMN morbidity and mortality rates have been relatively stable. In most cases, the diagnosis of malignant ovarian pathology has been based on the results of a pathomorphological investigation. The histological variant of the neoplasm significantly affects the prognosis for life. The most common neoplasms are serous ovarian carcinomas (69%). Neoplasms of non-epithelial origin occur in 8% of all cases. About 16% of women have multiple primary neoplasms with ovarian involvement. In most cases of metachronous development of polyneoplasia the ovarian neoplasm occurs last. The analysis of the age-specific morbidity showed that OMN was most often (52%) diagnosed at the age of 46-65 years. During the study period, about 70% of neoplasms were diagnosed at a later stage, 10% of patients were incurable and received only symptomatic therapy. The indicators of the quality of oncological care demonstrate an increase in the number of cases diagnosed at an early stage. In 2019, in the Grodno region, OMNs of stage I-II were diagnosed in 42% of patients. Conclusion. To improve oncological care for the population and reduce morbidity and mortality from OMNs, it is necessary to develop and implement a set of measures aimed primarily at early diagnosis of the disease and prevention of neoplasm development in the case of primary multiple forms.

ENDOSCOPIC TECHNOLOGIES IN THYROID SURGERY: INTERNATIONAL AND OWN EXPERIENCE

Topicality. With the development of endoscopic technology, minimally invasive interventions on the thyroid gland have been widely developed. The introduction of minimally invasive techniques into practice is associated with the desire to improve the cosmetic effect and reduce surgical trauma for patients. The aim: to study the most popular techniques used in minimally invasive thyroid surgery, to show the advantages and disadvantages of each technique, the likelihood of one or another postoperative complication depending on the method of surgical intervention on the thyroid gland. Material and methods: Among minimally invasive interventions, mini-approaches have become widespread: axillary, anterior thoracic, paraareolar, posterior, transoral. When performing video-assisted surgical interventions, an endoscopic stand, a standard set of instruments (clamps and scissors for endoscopic operations), retractors for creating an operating space are used. Results: Criteria for a differentiated approach to the choice of the method of minimally invasive surgical intervention on the thyroid gland have been substantiated. The main task when choosing a method of surgical intervention is its simplicity, the possibility of rapid development, economic efficiency, and safety. Conclusions: Ensuring the safety and correct technique of performing surgery with mandatory monitoring of the recurrent nerve, visualization of the parathyroid glands made it possible to obtain good clinical results in patients with this pathology.

ANAMNESIS MORBI OF DOCTOR FREUD: PSYCHO-HISTORICAL ANALYSIS

Sigmund Freud is known as a creator of psychoanalysis, developmental theory and models of personality. Freud's personality, his life story invariably attracts scientists, researchers and practitioners. This article is devoted to the history of Freud's illness, which lasted for 16 years, from 1923 until his death in 1939. Freud suffered from cancer of the upper jaw on the right. An attending physician who performed many operations and prosthetics for Freud was oral surgeon Hans Pichler. Freud bravely endured suffering of the illness. Despite the pains and difficulties in functioning, he continued to work on scientific works and receive patient visits. On September 21, 1939, family doctor Max Schur, at Freud's request, performed euthanasia by injecting a lethal dose of morphine. Among the factors that influenced Freud's decision to be euthanized, the hypothesis of loss of the meaning of further suffering is considered. The concept of meaning is implicitly embedded in understanding of functioning of the Ego in structural model of personality developed by Freud.

VARIABILITY OF BLOOD PRESSURE IN COMORBIDITY OF ARTERIAL HYPERTENSION AND ATRIAL FIBRILLATION

Background. Arterial hypertension plays a decisive role in the development of atrial fibrillation, being the most important risk factor. Purpose. Analyze the literature on modern concepts of the relationship between blood pressure variability and atrial fibrillation. Material and methods. We analyzed 53 literature sources. Results. Information about the modern mechanisms of atrial fibrillation formation in arterial hypertension has been obtained. Approaches to the choice of antihypertensive therapy in patients with arterial hypertension and atrial fibrillation have been described. Conclusions. Based on the studies presented in the literature, it was found that blood pressure variability has an additional contribution to cardiovascular risk. Reducing blood pressure variability can be added as one of the important strategies in the treatment of arterial hypertension and atrial fibrillation.