INITIAL ASSESSMENT FINDINGS IN PATIENTS WITH CONFIRMED WILSON’S DISEASE

Bacground. The optimization of Wilson’s disease (WD) diagnosis is one of the most disputable problem. Objective. The retrospective study of initial assessment findings under clinical suspicion for WD in 102 patients with the confirmed diagnosis. Material and methods. The results of laboratory tests and Kaiser-Fleischer rings (KF rings) identification under clinical suspicion for WD in 102 patients with the confirmed diagnosis. Results. At stage I, 17 patients (16.7%; 95% CI 10.7–25.1) were defined as having clinically definitive WD based on the combination of low serum ceruloplasmin and KF rings, 4 patients (3.9%; 95% CI 1.5–9.7) – based on the drop of ceruloplasmin level. After stage II, involving 24-hour urinary copper excretion evaluation, the rate of definitive diagnosis of WD reached 24,5% (95% CI 17.2 33.7). After stage III (genotyping for carriage of ATP7B gene mutations) – 56.9% (95% CI 47.2–66.0). Serum free copper increase was found in 54.9% (95% CI 41.4 67.7) of cases. Conclusions. Under clinical suspicion for WD, initial structured ophthalmological, laboratory and molecular-genetic assessment ensured the diagnosis of WD only in 56.9% (95% CI 56.9; 47.2–66.1). Frequent detection of serum free copper increase (54.9%, 95% CI 41.4 67.7) allows to use this test due to its greater availability as compared with 24-hour urinary copper excretion evaluation in WD diagnostics.

СУТОЧНАЯ МНОГОКАНАЛЬНАЯ РН-ИМПЕДАНСОМЕТРИЯ ПИЩЕВОДА В ДИАГНОСТИКЕ ГАСТРОЭЗОФАГЕАЛЬНОЙ РЕФЛЮКСНОЙ БОЛЕЗНИ (КЛИНИЧЕСКИЕ СЛУЧАИ)

Background. Gastroesophageal reflux disease (GERD) is an urgent problem of modern gastroenterology as well as the most common pathology of the upper gastrointestinal tract; it is a chronic disease that significantly reduces the patient's quality of life, increases the risk of developing Barrett's esophagus and esophageal adenocarcinoma. Objective. To assess the potentials of multichannel intraluminal pH impedance monitoring in the diagnosis of esophageal diseases. Material and methods. In 3 patients with clinical and endoscopic signs of GERD esophageal multichannel intraluminal pH-impedance monitoring was performed using the diagnostic equipment Digitrapper pH-Z from Given Imaging (USA). Results. 24-hour esophageal pH monitoring enabled to verify the diagnosis of GERD, to reveal a hypersensitive esophagus and manifestations of nocturnal acid breakthrough. Conclusions. Multichannel intraluminal pH-impedance monitoring is the "gold standard" for the diagnosis of esophageal diseases; it significantly expands opportunities of gastroenterologists in the treatment of GERD.

VITAMIN B1 BIOLOGICAL FUNCTION IMPLEMENTATION IN THE BLOOD OF PATIENTS WITH STOMACH CANCER UNDER SURGICAL INTERVENTION

Background. The probability of undergoing surgery always predetermines the state of stress in a person; therefore, it is advisable to search for ways to optimize and (or) reduce this unfavourable effect. Objective. To find out the mechanism of vitamin B1 antistress activity during surgery. Material and methods. Metabolism intensity was investigated on donors’ blood lysates (n = 19) and those of patients with stage III stomach cancer (n = 64), referred to an elective surgery, aged 51-70. The blood was taken from the cubital vein three days before the operation, after premedication, during the most traumatic moment of the operation, after extubation, as well as on the first and third days of the postoperative period. The surgery was performed under combined multicomponent anesthesia using nitric oxide, sodium hydroxybutyrate, and epidural block. Thiamine and thiamine diphosphate kinase activities were assessed by the concentration of the formed thiamine di- and triphosphates of the vitamin. The activities of thiamine mono-, di- and triphosphatases were determined by the release of inorganic phosphate. The concentration of inorganic phosphate was recorded colorimetrically. The content of B1 and its derivatives in the blood was determined by the method of ion-pair reversed-phase HPLC. Results. There has been observed an increased content of thiamine monophosphate and that of free thiamine in the blood of donors and patients with stomach cancer. The registered rate of the hydrolytic thiamine monophosphatase reaction is not high. At the stages of premedication and maximum trauma of surgical exposure, the concentration of monophosphoric ester rapidly decreases alongside with monophosphatase activation. Therefore, the thiamine monophosphate hydrolysis is the rate-limiting link of vitamin B1 metabolism. The level of free thiamine remains persistently increased at all stages of surgical treatment. Thiamine monophosphatase activity is manifested at two pH optima – of 6.0 and 9.0. Thiamine monophosphate hydrolysis at pH of 9.0 is catalyzed by alkaline phosphatase. At pH of 6.0, in addition to thiamine monophosphoric ester, the enzyme hydrolyzes only p-nitrophenyl phosphate, flavin mononucleotide and phosphotyrosine, that allows it to be classified as hepatic acid phosphatase. The noted changes in B1 metabolism under stress concern mainly non-coenzyme forms - thiamine mono-, triphosphate, and free thiamine, which are used at the stages of thiol reduction as important components of insulin synthesis. Conclusions. The use of vitamin B1 allows to optimize the development of the stress response at all stages of surgical treatment. Its protective effect is achieved through the activation of the insulin-synthetic function of the pancreas, which increases the level of immunoreactive insulin in the blood. The formation of the most favorable physiological conditions for insulin synthesis provides an increased background of free thiamine, which is created due to the hydrolysis of noncoenzyme forms of the vitamin. The relationship between thiamine metabolism and B2 exchange and regulation of intracellular signaling pathways has been traced.

NON-ALCOHOLIC FATTY LIVER DISEASE: WITH A FOCUS ON FRUCTOSE

Non-alcoholic fatty liver disease (NAFLD) is characterized by excessive accumulation of fat in the liver in the absence of secondary causes. The review presents data on the role of fructose in the accumulation of fat in the liver and the mechanisms of NAFLD development. A number of data have been obtained on the effects of fructose, in the form of sugar-containing and fructose-containing drinks, related to NAFLD development.

TRYPTOPHAN: A KEY METABOLITE OF HOMEOSTASIS AND A REGULATOR OF BODY FUNCTIONS

Background. Tryptophan is an essential amino acid found mainly in protein foods and its availability is highly dependent on a diet. A significant part of tryptophan is metabolized in the gastrointestinal tract by the intestinal microbiota, producing a number of biologically active molecules, including aryl hydrocarbon receptor ligands, kynurenines, and serotonin (5-hydroxytryptamine). Objective. To analyze scientific studies confirming the key role of tryptophan microbial catabolites on the function of a macroorganism. Material and methods. The analysis of 47 English-language literature sources containing information on the effects of tryptophan metabolites on the mammalian organism was carried out. Results. It has been established that tryptophan metabolism plays a central role both in a normal macroorganism and in pathological conditions, it being directly or indirectly controlled by the intestinal microbiota. Conclusions. Thus, tryptophan metabolism is an important therapeutic target, underutilized in the treatment of a number of chronic neurological pathologies and immunocompetent conditions. An important factor is the use of nutraceuticals and probiotics by microorganisms that modulate the metabolism of tryptophan in the intestine and stimulate the synthesis of specific metabolites.

NON-INVASIVE METHODS FOR ASSESSING HEPATIC GRAFT STEATOSIS IN A DECEASED DONOR WHO IS DECLARED BRAIN-DEAD

The increase in the number of patients requiring liver transplantation raises the question of expanding and clarifying the criteria of hepatic grafts suitability for transplantation, and also shows the need to develop new, fast and noninvasive methods for assessing the functional state of the liver at the stage of donor examination and treatment. Hepatic grafts with severe steatosis, previously considered unsuitable for transplantation due to the higher risk of primary graft failure, are now referred to as potential for transplantation. There are several ways to diagnose and determine the stage of steatosis, but, unfortunately, today none of them can give an accurate and rapid assessment of its grade in a hepatic graft. Currently, the "gold standard" for determining liver steatosis is a biopsy with subsequent examination of samples by a pathomorphologist. There are also prognostic models, non-invasive tests and instrumental methods, the effectiveness of which has been proven - these are ultrasound elastography, contrast computed tomography and contrast computed tomography with liver density measurement. The decision on the suitability of a hepatic graft for transplantation depends on many factors, both on the part of the donor and on the part of the recipient, and it would be correct to assume that these data should be taken into account in aggregate. The review covers all the approaches currently used to quantify and qualitatively assess steatosis in liver transplants from a brain-dead donor.

CHRONIC VIRAL HEPATITIS AND INFLAMMATORY BOWEL DISEASE

The article presents the results of a literature review devoted to the study of the problems of the concurrent course of inflammatory bowel diseases (IBD), which include ulcerative colitis (UC) and Crohn's disease (CD), as well as chronic viral hepatitis (CVH) - chronic hepatitis B (CHB) and chronic hepatitis C (CHC). The prevalence of CHB and CHC in IBD in different countries ranges from 1% to 9%. The clinical course of these concurrent diseases, the possibility of hepatitis B virus (HBV) and hepatitis C virus (HCV) reactivation during immunosuppressive therapy are described. Recommendations on the peculiarities of examination and management of patients with concurrent pathology of IBD and CVH are presented. The combined pathology of IBD and CVH is a significant public health problem worldwide that requires further largescale study. The use of immunosuppressive therapy for IBD can be accompanied by the activation of HBV and HCV infection, therefore, the management of such patients should occur on an individual basis.

PORTAL VEIN AND LIVER BARIUM EMBOLISM

Background. An upper and lower gastrointestinal (GI) series is an available and informative diagnostic test. Side effects are extremely rare. Objective. To present a case description of portal vein and liver barium embolism with a fatal outcome and explain the mechanism of its occurrence. Material and methods. The clinical manifestations, laboratory and instrumental findings, as well as autopsy of a female patient who died after lower GI radiography were analyzed. Results. To exclude intestinal obstruction, the patient underwent a barium follow through. Three days later, during X-ray computed tomography, barium and gas were detected in the inferior mesenteric vein, portal vein and its intrahepatic branches. During colonoscopy, diverticula of the sigmoid colon were detected, but the localization of the intestinalvenous fistula wasn’t determined. Conservative surgery failed and the death occurred 15 days after radiography. Conclusions. The autopsy revealed that the site of entry for the development of barium embolism as well as for gas, were diabrotic veins in peridiverticular abscesses localized in pericolic tissue.

HEPATITIS E VIRUS MONITORING RESULTS AND ITS LABORATORY SCREENING ALGORITHM

Background. Individual cases of viral hepatitis E are recorded in the Republic of Belarus annually indicating the need for the pathogen monitoring at both the population and reservoir levels. Objective. To consolidate the monitoring data on hepatitis E virus over the period of 2018 - 2021, as well as to work out an effective algorithm for its laboratory screening. Material and methods. As part of the study, 345 samples were analyzed, including 227 human biological samples, 37 samples of biological materials of domestic pigs, 22 samples of food and 59 samples of waste water. Results. According to the results of serum diagnostics, in the group of kidney recipients (n = 29), the detection rate of IgM and IgG to hepatitis E virus was 6.9% [0.85%; 23.03%] and 17.2% [7.13%; 35, 02%] respectively; in the group of patients with pregnancy pathology (n = 44) - 6.8% [1.68%; 18.89%] and 11.4% [4.5%; 24.43%] respectively. In patients with acute hepatitis of unknown etiology (n = 26), antiviral IgM was not detected, while the frequency of antiviral IgG detection reached 7.7% [1.02%; 25.26]. In control group (blood donors, n = 53) IgM and IgG were detected in 1.9% [0.6%; 10.88%] and 5.7% [1.35%; 15.97] of those examined respectively. Hepatitis E virus RNA was detected in 8 human biological samples (3.8%) from kidney recipients. The identified hepatitis E viruses were represented by genotype GIII and belonged to a previously unidentified subgenotype (GIIIa - GIIIi). In the studied samples of biological material from pigs, as well as in samples of food and waste water, hepatitis E virus RNA was not detected. Conclusions. An algorithm for hepatitis E virus laboratory screening has been developed and tested. Its section concerning the diagnosis of viral hepatitis E is set out in the Instructions for use "Algorithm for laboratory diagnosis of viral hepatitis E" (No. 148-1220 from January 28, 2021).

SURGICAL TREATMENT OF HYPERTENSION-DUCTAL TYPE OF CHRONIC PANCREATITIS, IN COMBINATION WITH BILIARY OBSTRUCTION SYNDROME

Background. The frequency of chronic pancreatitis and its complications is steadily increasing, which makes the problem of treating this pathology one of the most urgent and significant. Objective. Improvement of the results of surgical treatment of patients with hypertension-ductal type of chronic pancreatitis with extended stricture of the intrapancreatic part of the common bile duct. Material and methods. During the period 2006–2021, 328 operations were performed in the Grodno University Clinic due to chronic pancreatitis with pathology of the ductal system in combination with pancreatic cysts. The total number of complications was 5,1%. 18 patients with chronic recurrent pancreatitis, ductal hypertension in combination with a cyst of the head pancreas, also with extended stricture of the terminal part common bile duct and mechanical jaundice were operated on according to the methods developed in the clinic: 12 patients underwent choledochopancreatoejunostomy, 5 patients underwent choledochocystopancreatoejunostomy, choledochocystoduodenostomy was performed in 1 case. Results. The developed methods make it possible to perform adequate internal drainage of the ductal system of the pancreas and bile ducts, as well as cystic formations. Conclusions. The application of the developed methods improves the results of surgical treatment complicated chronic pancreatitis.