Primary aldosteronism is characterized by aldosterone secretion that is independent of renin and angiotensin II. The deleterious effects of primary aldosteronism are mediated by excessive activation of the mineralocorticoid receptor that results in the hypertension, hypokalemia, and it also increases the risk for cardiovascular and kidney disease, as well as death. Current evidence suggests that the prevalence of primary aldosteronism is much greater than previously recognized and milder forms of renin-independent aldosterone secretion may be common. These forms may be missed. This review focused screening in those at increased risk of primary aldosteronism. An approach to evaluating screening results was presented. Family aldosteronism should be considered in young hypertensive patients with a family history of primary aldosteronism. Genetic testing is appropriate in these patients. Careful interpretation of screening data, recent achievements in hormone assays and sampling methods and their clinical relevance are discussed. Confirmatory tests and evaluation of their results are considered. The optimal approach to distinguish unilateral from bilateral primary aldosteronism is by adrenal vein sampling that is the only reliable method to select patients for surgery. More effective strategy to diagnose PA should lead to early detection of PA and could decrease the cardiovascular complications of the patients.

The review is devoted to the toxicity and safety of nanosized forms of selenium. It is shown that in nature selenium exists mainly in the form of selenate (Se⁶⁺), selenite (Se⁴⁺), selenide (Se^2–) and elemental selenium (Se⁰), while the latter is insoluble in aqueous media, less toxic and biologically inert. In the form of nanosized particles, elemental selenium is not only biocompatible, but also has antitumor and antimicrobial activity.

It has been shown that elemental selenium in the form of nanoparticles can modulate the activity of the antioxidant and detoxification systems. A dose-dependent effect of selenium in nanosized form has been demonstrated. It has been shown that at high concentrations (above 2 mg Se per kg of animal weight) selenium nanoparticles can cause the development of selenium-induced toxicity in mammals.

It has been shown that elemental selenium in the form of nanoparticles can affect immunoregulation, reproductive function, kidney and liver function, modulate the activity of the antioxidant and detoxification systems, and in high concentrations (above 2 mg Se per kg of animal weight) cause the development of selenium-induced toxicity both in mammals and fish. At the same time, for fish, it was shown that selenium nanoparticles are more toxic than inorganic selenium and cause a more acute reaction of the body to exposure to even low concentrations, possibly associated with hyperaccumulation of selenium in tissues, which once again reminds us of the need to take into account the problems of ecotoxicity of selenium nanocomposites.

he negative impact of chronic inflammation on the onset and progression of endothelial dysfunction, blood pressure destabilization and renal function deterioration is widely discussed by modern researchers. One of the topical lines of research is studying the effect of osteoarthritis (OA) on the course of chronic heart failure (CHF). Using modern immunological cytokines in the treatment of such patients can contribute to an earlier diagnosis of the risk of decom-pensation of the cardiovascular pathology.
The aim of the study. To study the possibilities of using galectin-3 in CHF patients with preserved and moderately reduced left ventricular ejection fraction and osteoarthritis in combination with CHF decompensation factors.
Materials and methods. A cross-sectional study of 107 CHF patients was carried out: 60 patients formed the study group with combination of CHF and OA; 47 patients were included in comparison group with CHF and without OA. 
A comparative analysis of clinical, laboratory and instrumental parameters, as well as of the galectin-3 level was car-ried out. The relationship between galectin-3 and CHF decompensation factors in the study group was analyzed, and its diagnostic capabilities were assessed. Statistical processing was carried out using the Statistica 10.0 program (StatSoft Inc., USA). The critical level of statistical significance was p < 0.05.
Results. According to the results of the study, in the study group, a statistically significantly higher level of galectin-3 was revealed compared to the one in patients of the comparison group – 42 ± 2.2 and 20 ± 1.5 ng/ml respectively (p < 0.001), as well as statistically significant associations of galectin-3 with blood pressure levels, dyslipidemia, esti-mated glomerular filtration rate, and atrial natriuretic peptide.
Conclusion. The presence of a statistically significant association of galectin-3 with CHF decompensation factors in patients with osteoarthritis reveals new pathogenetic features of the course of this comorbid pathology. Apparently, it is possible to use galectin-3 as a marker for diagnosing decompensation in this group of patients.

Introduction. To date, many options for conservative and surgical treatment of patients with pilonidal cysts have been developed. Our studies on the use of laser radiation in the treatment of epithelial coccygeal passage, which began in 2007, showed its positive clinical effect, which is expressed in a decrease in the number of complications and relapses. The essence of the method lies in the thermal ablation of the walls of the coccygeal passage with laser radiation.

Aim. To study the effect of high-intensity laser radiation on the tissues of the pilonidal cyst in patients with epithelial coccygeal passage, in order to improve the results of treatment in this category of patients.

Materials and methods. The study was conducted for the period from 2018 to 2021. The patients were divided into 2 groups depending on the type of surgical treatment. The first group consisted of 124 patients who underwent traditional excision of the pilonidal cyst with primary sutures. The second group included 60 patients who underwent laser-induced interstitial thermotherapy (LIIT). To study microcirculatory changes in the tissues of the pilonidal cyst area at the time of the surgical injury, the Spectrotest apparatus was used.

Results. The analysis of research materials was carried out in two statistically homogeneous groups. During dynamic studies, we have established certain changes in the parameters of microcirculation and tissue saturation, depending on the type of surgical treatment performed. After the operations in the first group, there was a significant violation of microcirculation, and hence tissue saturation in the walls of postoperative wounds. In the second group of patients, microcirculatory disorders were less pronounced, and their normalization occurred much earlier. Thus, a decrease in the volumetric rate of capillary circulation and tissue saturation in this group of patients practically did not occur. This indicates the absence of ischemia of the surrounding tissues around the treated area. When measuring temperature fields in the walls of pilonidal cysts in LIIT, temperatures were set from 56 to 65°C, i.e. the temperature of destruction of proteins included in the structure of the cyst walls. On the surface and in the tissues surrounding the cyst, the maximum recorded temperature is 40°C, and this does not lead to destruction, which is also confirmed by morphological data.

Conclusions. High-intensity laser radiation leads to obliteration of the cystic cavity, the formation of scar tissue, the elimination of specific symptoms and a decrease in the risk of recurrence of pilonidal disease, which is confirmed by spectroscopy, thermometry and histological studies.

Background. Sporadic multiglandular parathyroid disease remains an unresolved problem in endocrine surgery. This is due to the complexity of clinical and laboratory prediction, insufficient sensitivity of imaging methods and intraoperative monitoring of intact parathyroid hormone.

Аim is to develop a predictive scale for multiple lesions of the parathyroid glands in primary hyperparathyroidism.

Materials and methods. A single-center prospective study was conducted, including 126 cases of surgical treatment of primary hyperparathyroidism (2019-2021). The main endpoint of the study was to develop a scale for predicting multiple PTG lesions in PHPT using the method of mathematical analysis.

Results. The developed scale includes determination of serum levels of albumin-corrected calcium and parathyroid hormone, glomerular filtration rate (GFR), measurement of parathyroid glands parameters according to ultrasound and/or scintigraphy and assessment of the consistency of these results and determination of the value of the coefficient K_IB. The results are evaluated in points. If the total score is less than 2, multiglandular parathyroid disease is diagnosed, equal to or more than 2 - one gland.

Conclusion. Mathematical prediction of sporadic multiglandular parathyroid disease allows clarifying the preoperative diagnosis and planning the scope of surgical treatment.

Abstract:

POEMS syndrome is a rare systemic disease that manifests with the following main symptoms: polyneuropathy, organomegaly, endocrinopathy, paraproteinemia, skin changes. A clinical case of POEMS syndrome in a 42-year-old patient is presented. The diagnosis was verified after the appearance and increase of extraneural symptoms, such as severe edema, respiratory failure, endocrinopathy, hepatosplenomegaly, lymphadenopathy. Additional patient examinations have been done and typical for this disease paraproteinemia has been identified. A course of specific therapy was undertaken in the hematology department, a positive effect was noted. Due to multisystem organ damage, there may be a variety of onset of the disease, which makes it difficult to correctly diagnose and prescribe appropriate therapy.

The article discusses a treatment of a 30-year-old patient with a newly diagnosed diaphragmatic Morgagni-Larrey hernia. Among diaphragmatic hernias, Morgagni-Larrey pathology occurs in 26 % of cases, mostly on the right side. Data on access options for abdominal-mediastinal hernias are presented. In the presented case report, the planned surgical intervention was performed from laparotomy access. The hernia content was represented by a transverse colon and a large omentum, as in most reported cases. We removed the hernial sac and performed plastic repair of the defect with local diaphragm tissues. Taking into account that the discussed pathology decreases the quality of life and has a risk of complications, it is appropriate to perform elective surgical interventions in such patients. Choice of operative access, technique of diaphragm plastic surgery and need for the hernial sac excision are the matters of further consideration.

Abstract. The lecture presents the stages and mechanisms of development of the stress response, its biological significance, describes the main types of stressors, the effects of hormones involved in the development of stress. The functions of individual components of the stress system and their interaction are shown. The adaptive effects of stress, as well as its role in the formation of human pathology, are analyzed in detail. Attention is paid to psycho-emotional stress, the features of its development and the impact on the body, including psychosomatic pathology.

The lecture examines the role of modern genetics and its significance for medicine. The goals of genetics and its structure are determined. It is shown that modern medical genetics is divided into general genetics, clinical genetics and laboratory genetics. Also highlighted are such areas of genetics as genomics, molecular and biochemical genetics, cytogenetics, developmental genetics, oncogenetics and immunogenetics, pharmacogenetics, population genetics, ecological genetics, nutrigenetics, toxigenetics. It is noted that about 20-40% of clinic patients are patients with hereditary pathology. The main possibilities of modern genetics, such as sequencing of the human genome, molecular genetic diagnosis of hereditary pathology, personalized medicine, genetic certification, identification of genetic markers of oncological diseases, determination of individual sensitivity to drugs using pharmacogenetics methods, gene therapy of previously incurable diseases, bioengineering in the field of medicine and genome editing. The issues of biological aging of the body and the possibility of prolonging active longevity by the methods of modern genetics are touched upon. Conclusions are drawn about the need to introduce into the system of higher medical education knowledge, skills in the field of propaedeutics of clinical genetics, genetic testing, interpretation of its results, treatment and prevention using modern genetics methods.