Journal «MEDICINA» 1/2025

Hemocontact viral hepatitis can remain undetected for a long time due to the prolonged incubation period (up to 180 days) and the absence (or mild nature) of symptoms. When seeking medical care, such patients become sources of nosocomial infections. The aim of the study is to assess some epidemiological aspects of the incidence of hemocontact hepatitis B and C in a large region. Materials and methods included data from reporting form No. 2 of the Federal State Statistical Observation «Information on Infectious and Parasitic Diseases» in the Altai Territory for the period 2000-2023. The results of the study revealed that in the Altai Territoryi, the proportion of hepatitis C in the structure of viral hepatitis incidence has increased. Over the past two years, there has been a trend toward an increase in the incidence of chronic hepatitis B and C. The adult population contributes the most to the age structure of hemocontact viral hepatitis incidence.

Key words: hemocontact hepatitis, hepatitis B, hepatitis C, epidemiology, dynamics and structure of morbidity, retrospective analysis

Microsatellite instability (MSI) is a predisposition to mutations resulting from impaired DNA mismatch repair and is an important factor in the occurrence and development of tumors. The aim of this study was to describe MSI using markers MLH1, PMS2, MSH2, and MSH6 in epithelial cells of benign gastric lesions. It was found that the phenomenon of microsatellite instability was observed in polypoid gastric lesions, except for foveolar hyperplasia, in the following percentages: in hyperplastic polyps – low-level MSI (40%), high-level MSI (19%), and absence of MSI (41%); in foveolar-type adenoma with low-grade dysplasia – low-level MSI (18.8%), high-level MSI (31.2%), and absence of MSI (50%); in foveolar-type adenoma with high-grade dysplasia – low-level MSI (0%), high-level MSI (42%), and absence of MSI (58%). The highest response was observed in foveolar-type adenoma with high-grade and low-grade dysplasia, suggesting that microsatellite instability may play a role in the process of malignant transformation.

Key words: microsatellite instability, hyperplastic polyps, adenomatous polyps, immunohistochemical method

A naturalistic observational comparative study was conducted on two groups of patients: 105 individuals with alcohol dependence complicated by epileptic seizures and 83 individuals with alcohol dependence without epileptic seizures. It was shown that the studied patient population had a more severe course of the disease, which was manifested in a predominance of high disease progression, continuous drinking patterns, frequent repeated hospitalizations, and frequent complications of withdrawal syndrome in the form of delirium tremens. Binary analysis revealed a close relationship between biological and environmental factors. In the presence of aggravating biological factors, the course of the disease worsens, it develops at an earlier age, has high progression, and is associated with an increased frequency of traumatic brain injuries (TBI) as well as a higher incidence and frequency of psychoses.

Key words: alcohol dependence, epileptic seizures, delirium tremens, comorbidity

Introduction: In recent decades, Russia, like the rest of the world, has seen a rapid increase in antimicrobial resistance (AMR) among pathogens causing infectious diseases. The development of drug resistance leads to microorganisms' ability to survive despite the use of etiotropic therapy. Alongside multidrug resistance (MDR), hypervirulence – associated with the acquisition of additional genetic material and the emergence of new genetic lineages – is becoming increasingly significant. The purpose of the study: To conduct a comparative phenotypic and genotypic assessment of the main pathogens causing healthcare-associated infections (HAIs) isolated from patients in a large multidisciplinary hospital. Materials and methods: The study involved whole-genome sequencing of 50 multidrug-resistant (MDR) strains isolated from patients with HAIs in a major multidisciplinary healthcare facility. The sample included 40 K. pneumoniae strains, 8 A. baumannii strains, and 2 P. aeruginosa strains obtained from clinical specimens in a multidisciplinary hospital. Pure cultures were isolated using bacteriological methods with blood agar and selective media – MacConkey agar (BioMerieux, France) and Levin agar (OXOID, UK). Antibiotic resistance was determined using the disk diffusion method. The results of the study and their discussion. The study found that A. baumannii most frequently caused HAIs in the form of systemic infections (50% of cases), which was 20.6% less than K. pneumoniae. Genotypic analysis of A. baumannii revealed the presence of acquired carbapenemase genes, including: OXA-48 (14.2%), OXA-23 (42.8%), OXA-40 (14.2%) and extended-spectrum beta-lactamase (ESBL) genes of the CTX-M group (28.8%). For K. pneumoniae, the following resistance genes were identified: Metallo-beta-lactamases (MBLs) of the NDM group (14.6%), Carbapenemases of the OXA-48-like group (44.1%), ESBL genes of the CTX-M group (41.3%). Conclusions: The comparative data on the genotypic resistance of K. pneumoniae and A. baumannii strains in a large regional healthcare facility highlight the clinical and epidemiological aspects of hospital-acquired strain formation. These findings help clinicians and epidemiologists identify high-risk groups for HAIs, adjust treatment regimens, improve preventive and infection control measures, and predict the emergence and spread of hospital-resistant strains. 

Key words: healthcare-associated infections, genotypic resistance, risk factors, antibiotic resistance, resistance genes

In this article, an interdisciplinary group of authors examines the legal and clinical aspects of pain management in cancer patients belonging to clinical groups II–III. Special attention is given to the use of effective chronic pain syndrome therapy with opioid analgesics, as opposed to prescribing nonsteroidal anti-inflammatory drugs. At the same time, the regulatory barriers to prescribing effective pain therapy are explored, which stem from the lack of clinical guidelines for treating chronic pain syndrome in patients of clinical groups II–III.

Key words: chronic pain syndrome, palliative care, opioid analgesics, legal regulation, regulatory barriers

Myopia, especially high myopia, is a significant risk factor for the development of peripheral vitreochorioretinal dystrophies (PVRD), early detection and treatment of which is an effective method for preventing retinal detachment. The objective of the study was to determine the frequency and structure of PVRD, the need for laser coagulation of the retina in pediatric patients with myopia observed in a large ophthalmology clinic.

Key words: peripheral vitreochorioretinal dystrophies, PVRD, children, myopia

In recent years, chemotherapy for esophageal cancer has undergone significant changes. The emergence of new immunotherapeutic drugs has created new lines of therapy and significantly improved overall survival and progression-free survival rates in these patients. However, not all patients currently have access to modern treatments. Unfortunately, there is limited published data on the distribution of patients across different therapy options, as well as on treatment choices for patients in later lines of therapy. This article provides an overview of the available data on patient distribution across therapy lines and options.

Key words: esophageal cancer, immunotherapy, modern cancer treatment, esophageal cancer statistics

Cataract surgery is one of the oldest operations described in medical literature. Although numerous articles on this topic have been published over time, we will highlight key moments in the long history of cataract surgery. In our historical overview, we discovered fascinating details that influence modern trends in phaco surgery. The progress achieved in this field is remarkable. The earliest procedures were performed using primitive instruments, but today, advanced phacoemulsification techniques combined with femtosecond laser technology deliver excellent outcomes, restoring vision to our patients.

Key words: eye, cataract, extracapsular extraction, intraocular lenses, phacoemulsification, femtosecond laser