Objective: to evaluate the results of transcatheter arterial embolization in patients with acute and chronic pancreatitis complicated by left-sided portal hypertension and bleeding from varicose veins of the stomach fundus and body.

Materials and methods: 5 patients with left-sided portal hypertension were treated. Patients were admitted with a clinical picture of gastrointestinal bleeding, which was confirmed by laboratory and instrumental methods of research. Fibrogastroduodenoscopy revealed bleeding from varicose veins of the fundus and body of the stomach in all patients. The average age was 55.4±3.1 years.

Results. All patients showed varicose veins of the fundus and body of the stomach, with signs of bleeding. Due to the high risk of recurrent bleeding, subtractive digital angiography with no signs of contrast agent extravasation was performed, followed by spiral embolization of the splenic artery in the proximal third until the blood flow was stopped. The technical and clinical success rate was 100%.

Conclusion. Endovascular methods of treatment for left-sided portal hypertension syndrome are minimally invasive but highly effective methods of hemostasis. The indication for their use is unsuccessful endoscopic hemostasis or high risk of recurrence of bleeding from varicose veins of the fundus and body of the stomach.

Objective: studying the interrelations of the local oral immunity indicators which allow to predict the severity of phlegmons course in patients with maxillofacial region phlegmons against the background of insulin-independent diabetes mellitus.

Materials and methods. 44 patients were included in this prospective study. The main group: 19 patients with the maxillofacial region phlegmons and the type 2 diabetes mellitus as a concomitant pathology (PH+DM). The comparison group: 20 patients with the maxillofacial region phlegmons with no diabetes mellitus among the concomitant pathologies (PH). The control group: 5 patients were undergoing routine surgical treatment in the maxillofacial surgery department. The groups were comparable in age, gender, and phlegmon treatment (p > 0.05). Levels of the proinflammatory and anti-inflammatory cytokines, the humoral immunity factors and the microbial adsorption reaction (MAR) index to the oral epithelial cells were determined in the saliva of patients on the 1^st and 5^th days. The obtained data were statistically processed.

Results. On the 1^st day of hospital treatment the PH+DM group revealed an increase in interleukin-6, a decrease in interleukin-10 and lactoferrin as compared to the PH and control groups (p < 0.05). On the 5^th day of the treatment the interleukin-6 and tumor necrosis factor-α levels did not differ between PH+DM and the control groups (p < 0.05). The interleukin-4 and interleukin-10 levels were lower in the PH+DM and PH groups than in the control group on the 5^th day (p < 0.05). The lactoferrin level in the PH+DM group was lower than in the PH and control groups (p < 0.05). The significant negative correlation was found between the MAR index values and SOFA (Sequential organ failure assessment score) points in patients with sepsis, R = -0.9 (p < 0.05).

Conclusion. The delayed regression of the saliva inflammation indicators was specific for the PH+DM group patients in comparison with the PH group patients. The MAR index below 10% may be a predictor of unfavorable course of the phlegmon development.

The objective is to provide an overview of the literature data concerning the optimization of pharmacotherapy of comorbid pathology - chronic heart failure and diabetes mellitus. The article discusses the pathogenetic mechanisms of the negative mutual influence of chronic heart failure (CHF) and type 2 diabetes mellitus (T2DM) on their course and prognosis in patients with this comorbid pathology. Along with the discussion of the leading groups of drugs used for the treatment of CHF with a reduced left ventricular ejection fraction in patients with T2DM, priority classes of drugs for the treatment of patients with diastolic heart failure and their effect on the prognosis in the discussed contingent of patients are considered. An important area of therapy for people with CHF and T2DM is the use of hypoglycemic drugs that can have a positive effect on the course of cardiac pathology and change the prognosis in such patients. The article discusses the results of a number of randomized clinical trials evaluating the cardioprotective effect of modern classes of hypoglycemic agents: dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, sodium-glucose cotransporter-2 (SGLT-2) inhibitors. According to the presented studies, DPP-4 inhibitors, GLP-1 receptor agonists had a neutral or favorable effect on the prognosis in patients with cardiovascular diseases of atherosclerotic genesis and/or risk factors for their development, but did not affect the course of CHF. For the current period, the most significant drugs in terms of a positive effect on the prognosis in patients with diabetes mellitus and CHF are those from the SGLT-2 inhibitors group. The paper discusses in detail the results of clinical studies on the use of agents of the above-mentioned group in persons with CHF and diabetes mellitus and reviews the pharmacodynamic mechanisms that determine the cardioprotective effect of these drugs. The paper presents modern data that allow discussing the prospects for the use of SGLT-2 inhibitors in patients with CHF without T2DM.

Objective. The paper analyzes the immunological parameters to identify their hidden relationships and informativeness by multivariate analysis in patients with seasonal allergic rhinitis taking into account gender differences.

Materials and methods. The immune status of 112 patients with seasonal allergic rhinitis was examined. The number of eosinophils, the phenotype of lymphocytes (CD3⁺CD4⁺; CD3⁺CD8⁺; CD3^-CD19⁺), the concentrations of cytokines (IL-1β, IL-4, IL-8, IL-10, IFN-γ), antimicrobial peptide - α-defensin (HNP1-3), and serum immunoglobulin E was investigated. The principal components were analyzed.

Results. The results obtained enabled to identify the most important principal components of immunological parameters, taking into account the magnitude of the correlation coefficients in patients with seasonal allergic rhinitis. The role of various immunity indicators and their contribution to the immune system functioning was studied considering gender differences. In women in the first complex, CD4 (r = -0.75), CD19 (r = -0.70) have the greatest influence, in the second one - Ig E (r = 0.73) and blood eosinophils (r = 0.78). In men in the first complex, a high contribution was made by the serum Ig E concentration (r = 0.87) and the blood eosinophils number (r = 0.82). The high contribution of the serum IL 10 level (r = 0.72) in women is reflected in the fifth complex, where the age was the most significant for men (r = 0.82).

Conclusion. The multivariate analysis method using confirms the possibility of revealing hidden relationships between the studied parameters. The detection of connected combinations between immunological parameters creates the main complexes, taking into account their contribution to the general characteristics of the immune system in patients with seasonal allergic rhinitis.

The review article discusses the prevalence, etiology, pathogenesis, and treatment of spontaneous pneumothorax. The vascular, mechanical, obstructive, infectious, and enzymatic theories of the occurrence of emphysematous lung changes as the main cause of developing spontaneous pneumothorax are described; the role of smoking as the main etiological factor and its influence on the recurrence rate of spontaneous pneumothorax are studied. The issues of choosing primary cure tactic are considered. The effectiveness of conservative treatment, puncture and drainage of the pleural cavity as methods of treatment and pleurodesis for the prevention of recurrences of spontaneous pneumothorax are described. A comparativeassessment of various methods of pleural cavity obliteration is given: chemical pleurodesis (by sterile talc, minocycline, povidone-iodine, 50% glucose solution, autologous blood and its components, autologous adipose tissue, pseudomonas aeruginosa sensitive hemagglutinin, picibanil), apical pleurectomy, pleuroabrasion. The experience of using YAG-ND and CO₂ as methods of physical pleurodesis, intraoperative Staple Line Coverage with polyglyconic acid and fibrin gel is described. The necessity of active surgical tactic in the treatment of patients with spontaneous pneumothorax developed on the base of undifferentiated connective tissue dysplasia has been substantiated. The advantages, disadvantages, indications and contrindications to different ways of surgical treatment (thoracotomy, video-assisted minithoracotomy, thoracoscopy) are discussed. The strategy for choosing treatment methods depending on the volume of pneumothorax, the severity of bullous changes, the presence of concomitant diseases, chronic obstructive pulmonary disease, and the value of the Charlson comorbidity index is considered. The expediency of using video-assisted minithoracotomy as the safest and most effective method of surgical treatment of spontaneous pneumothorax has been substantiated. The effectiveness of surgical interventions depending on the timing of their implementation is considered.

The objective: to determine the frequency of insomniac disorders in patients with traumatic brain injury (TBI) complicated with subdural hematoma, for early detection and prevention of sleep disorders in recovery periods.

Materials and methods. A survey was conducted in 102 patients with TBI complicated with acute subdural hematoma who were operated on in the Neurosurgical Department of the M.A. Tverye State medical center in Perm in the period from 2018 to 2019. The study included patients with the most frequent localization of subdural hematoma. Group I consisted of 31 patients (30%) with a hematoma localized in the frontotemporal region, group II - 28 patients (27%) with a hematoma localized in the parietal - temporal region, group III - 18 patients (18%) with a hematoma localized in the frontotemporal - occipital region, group IV - 25 patients (25%) with a hematoma localized in the parietal-occipital region. On day 13-14 after surgical intervention to remove the subdural hematoma, the patients were interviewed using the ISI scale to determine the presence and severity of insomnia.

Results. The severity of condition on admission was assessed as 13-12 points on the Glasgow scale in the largest number of patients. The most severe general condition on admission was noted in patients with subdural hematoma localized in the frontal-parietal-occipital area. Out of 102 patients, only one patient was found to have moderate sleep disturbances when assessing the insomnia severity index and 13 patients were found to have mild sleep disturbances. The most common complaints of the patients when interviewed were a feeling of heaviness in the head after sleep, intermittent, shallow sleep.

Conclusion. Interrupted sleep and heaviness in the head afterwards, as well as the need for daytime sleep, are the most frequent complaints about the sleep process in patients with a traumatic brain injury complicated with a subdural hematoma on the 13th-14th day after injury.

The objective is to study the effects of Gly-His-Lys-D-Ala (GHK-D-Ala) peptide on mechanisms of innate immunity and lipid peroxidation processes in infected wound.

Materials and methods. The experiments were carried out on 80 Wistar male rats. The infected wound was modeled by applying a full-layer wound on the back and performing primary wound surgery with primary suturing 24 hours later. GHK-D-Ala peptide was injected at a dose of 0.5 µg/kg into the wound area every day for 30 days. The phagocytic activity of blood neutrophils was studied in spontaneous and stimulated nitroblue tetrazolium reduction test (NBT-test). The activity of lipid peroxidation (LPO) processes in rats’ blood serum was assessed by the content of malondialdehyde (MDA) and acylhydroperoxides (AHP).

Results. GHK-D-Ala administration had a positive effect on both phagocytosis mechanisms and the level of LPO products in comparison with the control group. There was a significant increase in NST-positive neutrophils in the spontaneous test against peptide administration on days 3, 7, 10, and 30 (p˂0.001) and in the stimulated NST test on days 3, 7, and 10 (p < 0.001). The functional neutrophil reserve had been significantly increased by day 10 (p˂0.05) and had been significantly lower by day 30 (p < 0.05). Phagocytic index and phagocytic number were significantly higher on days 3 and 10 (p < 0.01). The phagocyte activity index significantly increased on days 3 and 10 (p < 0.05-0.001).A significant decrease in the MDA concentration was demonstrated on days 3, 7, 10, and 30 (p<0,001). There was a significant decrease in the content of AGP on days 3, 7, 10 and 30 (p < 0.001).

Conclusion. The corrective effect of Gly-His-Lys-D-Ala peptide on the phagocytic activity of granulocytes and the processes of lipid peroxidation in infected skin wounds was established.

Objective - study of isolating Stavudine from biological fluids (urine, blood plasma).

Materials and methods. Objects of research: substance and tablets of 30 mg Stavudine. Reagents: purified water, chloroform, ethyl acetate, dichloromethane, ether, heptane, toluene, acetone, 95% ethyl alcohol, 0.1 M hydrochloric acid solution, 10% ammonium hydroxide solution, 5%solutions of sodium sulfate, 20%sodium sulfate saturated, sodium chloride, sodium chloride saturated, 20%ammonium sulfate, ammonium sulfate saturated. Universal ionomer IT-1101. Stavudine was isolated by liquid-liquid extraction. To detect and quantify Stavudine, thin - layer sorbent chromatography (TLC) and UV spectrophotometry were used. Statistical data processing was performed using the software package for Windows XP (Microsoft Excel), and using the Student's t-test.

Results. When using thin-layer chromatography to identify Stavudine, it was found that the R_f value of the spots of Stavudine extracts from biological material corresponded to the R_f value range of 0.67-0.69. The R_f spot value of the standard Stavudine witness sample corresponded to (0.68±0.01). The stability study showed that the Stavudine solution is stable in a hydrochloric acid solution of 0.1 M, in which the absorption spectrum of Stavudine is characterized by absorption maxima at wavelengths of 209±1 and 267±1 nm. The wavelength of 267±1 nm was chosen as the analytical wavelength for the quantitative determination of Stavudine. In the course of the study, various factors affecting the degree of extraction of Stavudine from aqueous solutions were studied. The extractant is ethyl acetate, pH 3, the electrolyte is a saturated solution of ammonium sulfate. The extraction time is 7 minutes, twice.

Conclusion. Methods of identification and quantitative determination of Stavudine in extracts from urine and blood plasma by TLC and UV spectrophotometry have been developed. Methods of isolation of Stavudine from urine and blood plasma using the liquid-liquid extraction method have been developed (93.33±2.02%; 89.77±2.02% respectively).

The genus Alfalfa of the legume family (Fabaceae) includes about 60 species of herbaceous plants. One of the most widespread representatives in Russia and Kazakhstan is Medicago lupulina L. In the scientific medicine of Russia and Kazakhstan Medicago lupulina L. is currently not used. There is no approved pharmacopoeial article for this plant. However, this species has long been used in traditional medicine for a variety of diseases. For introduction into scientific medicine, it is necessary to develop authenticity indicators and conduct a study of morphological and anatomical signs of the structure of Medicago lupulina L. flowers.

Objective: to conduct a macro-and microscopic study of the structure of the alfalfa hop flowers; to identify and characterize the signs that are of differential importance in the diagnosis of raw materials.

Materials and methods. The study of morphological and anatomical features of Medicago lupulina L. was carried out in accordance with the articles of the State Pharmacopoeia of the Russian Federation of the XIV edition and the State Pharmacopoeia of the Republic of Kazakhstan. Freshly harvested, dried and fixed raw materials were used for the study.

Results. For the first time, macro- and microdiagnostic signs of flowers of Medicago lupulina L. were described.

Conclusion. For the first time macroscopic and microscopic features of flowers of Medicago lupulina L. were identified and described, which can be used to determine the authenticity of raw materials, as well as to develop the sections «External signs» and «Microscopic signs» of modern regulatory documentation.