Our journal summarizes the scientific activities of doctors and teachers in the spring semester. About 40 scientific papers were submitted to the journal this half-year. We were not able to publish all the works by the decision of our reviewers and experts. However, we highly appreciate the work of the authors who sent their works, but we select the best ones for discussion on the pages of the journal. The purpose of our journal is to provide a comprehensive coverage of scientific papers in surgery, pathological physiology and internal medicine, and we strictly adhere to the criterion of "corresponding to scientific specialties". One of the most important requirements that we impose on the work is high relevance and novelty, as well as a deep study of the research topic, which makes scientific work a textbook for young doctors and students.

The article contains a historical excursion into esophageal surgery, describes the history of the origin of transchiatic access to the mediastinum, which was the key to operations on the distal esophagus, and provides an overview of surgical procedures for the hernia of the esophageal orifice of the diaphragm. The methods were divided into two groups: one of them imagines methods that are performed for a long time, these are fundoplications according to Nissen, Dor, Toupet, Chernousov, who have proven themselves as effective and time-tested, the second group included relatively recently developed and implemented operations in clinical practice, such as Operation Stretta, transoral endoscopic fundoplication  cardioteresplasty, installation of a LINX system. The article provides historical facts, a brief description of each method, advantages and disadvantages. The analysis showed that some non-classical methods can be used, but each method must be applied selectively and individually. Given that one hundred percent effectiveness of methods has not yet been achieved, the search for new methods remains relevant.

Alcohol consumption is one of the main causes leading to chronic liver disease. Alcoholic liver disease is a set of cascading events, consisting first of alcoholic hepatic steatosis and then mainly through alcoholic steatohepatitis, leading to cirrhosis and hepatocellular carcinoma. This review considers chronic alcohol intoxication as the main factor in the development of liver disease. Modern data on the prevalence of forms of alcoholic liver damage in Russia and in the world are presented. The role of the consumed dose of ethanol, the nature of the alcoholic beverage, as well as the pattern of alcohol consumption in the formation of liver damage is assessed, predisposing factors are presented. The leading risk factors for alcoholic liver damage are: female gender, hereditary predisposition (ethnicity), trophological status (underweight or obesity), taking certain hepatotoxic drugs, the amount and duration of alcohol consumption and the type of alcohol consumed, smoking. The presence of concomitant viral hepatitis, environmental toxico-ecological influence and prenatal intoxication also predispose to alcoholic liver damage. The article provides a detailed assessment of the role of the presented risk factors in the development of alcoholic liver damage. However, it is not possible to identify the dominant risk factor for alcoholic liver damage, since the development of liver pathology directly depends not only on the amount of alcohol consumed, but also on the individual combination of predisposing factors. Understanding the etiology of the disease and the contribution of modifiable risk factors to its development will allow the development of effective strategies aimed at reducing the incidence and mortality from liver diseases.

Aim. Risk assessment of the introduction of resistant strains of microorganisms and the formation of their hospital forms in the Clinics of the Irkutsk State Medical University (Clinics of the ISMU)

Materials and methods.  To analyze how the level of resistance of microbial strains isolated from patients effect the form of the disease the case histories of patients of the Clinic of the State Medical University for 2022 (n=123) were used.

Bacteriological study of microbial contamination of air and environmental objects in the Clinics of the State Medical University in 2022 using swabs and aspiration method (n = 4523).

Result. When comparing acute and chronic forms of diseases among groups of patients with highly resistant and low resistant strains of microorganisms, a statistically significant difference was found χ2 = 6.2 p<0.012.

In 2022, in the structural subdivisions of the ISMU Clinics, positive results of washings from environmental objects were recorded in only 0.3% (95% CI 0.14 - 0.46) of studies.

In the treatment room of the ENT department of the Clinic of the State Medical University in November 2022, during routine microbiological monitoring, S. aureus, which is resistant to benzylpenicillin, was isolated once. Microbiological study of biomaterial from patients of the ENT department who were hospitalized in the same period showed the presence of S. aureus which has identical resistance to antibiotics in one patient.

The maximum level of resistance was registered in S. epidermidis, isolated from the biomaterial from the patient of the otorhinolaryngological department, and amounted to 88.9%.

Conclusion. Chronic forms of diseases are associated with the presence of highly resistant strains of microorganisms in a patient. Given the constant circulation of resistant pathogens among patients, there is a risk of introduction and formation of hospital clones of microorganisms in medical organizations.

A study of the etiological structure of chronic viral hepatitis is presented, taking into account the assessment of the stage of the pathological process and the genotypic affiliation of pathogens in the Khorezm region of the Republic of Uzbekistan. It is shown that in the Khorezm region of Uzbekistan in the etiological structure of chronic viral hepatitis are presented as monoinfection in 42.3% of cases, in 70.7% of cases in association with other forms, including chronic hepatitis C in the form of monoinfection is 29.3 %, and in association with other forms 42.4%. The frequency of chronic hepatitis D is 15.3%. The phenomena of fibrosis are observed in 95.8% of patients with chronic viral hepatitis and are aggravated by the association of various forms of chronic viral hepatitis. The dominant genotype is genotype 1b of viral hepatitis C. The frequency of detection of this genotype increases with the progression of the stage of the disease. In patients with chronic viral hepatitis D, all amplified isolates belonged to the HBV genotype, and HDV isolates to genotype 1.

Conclusion. When treating and diagnosing chronic viral hepatitis, their etiological picture should be taken into account. This will more effectively solve the problems of implementing the Strategy of the World Health Organization and the Government of the Republic of Uzbekistan in relation to chronic viral hepatitis.

The paper describes a clinical case of Duchenne myodystrophy at the stage of manifestation of clinical manifestations. The problems of diagnosing mutations in the DMD gene are considered. The paper presents clinical and laboratory data for Duchenne myodystrophy. It is noted that the difficulty of clinical diagnosis of Duchenne myodystrophy is associated with the presence of a preclinical period, in which the main diagnostic marker is an increase in transaminases, lactate dehydrogenase and creatine phosphokinase, as well as varying degrees of severity of clinical manifestations. Low alertness of doctors to hereditary pathology at the preclinical stage of the disease was noted. Molecular genetic diagnosis is difficult due to the large size of the DMD gene, which, when the reading frame is violated, gives a large number of different mutation variants. It is noted that modern pathogenetic therapy of this disease is ineffective, and the most promising areas of etiological treatment are gene therapy and cell technologies. Conclusion. Difficulties in diagnosing hereditary myodystrophy are associated with low awareness and alertness of doctors regarding hereditary pathology. For the effective treatment of patients with Duchenne myodystrophy, it is necessary to introduce etiological methods of treatment into medical activities.

Inflammation is the most widespread pathological process in medical practice. Inflammation is the basis of the vast majority of diseases. In this connection, the topic is actual for any medical student, as well as a doctor of any specialty. Local signs of inflammation (redness, swelling, heat, pain, dysfunction) were described more than two thousand years ago. Like any typical pathological process, inflammation includes protective and damaging reactions. Their knowledge is very important for understanding the pathogenesis of inflammatory diseases. The first part of the lecture describes the causes and mechanisms leading to the development of inflammation, as well as the consequences of tissue damage (acidosis, hyperonkia, hyperosmia, synthesis and release of inflammatory mediators). Inflammatory mediators are biologically active substances those regulate all reactions in the focus of inflammation. Various cells (neutrophils, macrophages, lymphocytes, endothelial cells, hepatocytes, etc.) can be sources of mediators. By origin, mediators are divided into cell-derived (biogenic amines, derivatives of arachidonic acid, lysosomal enzymes and reactive oxygen species, cytokines) and plasma-derived (components of the complement system, kinins and the hemostasis system). There are pro-inflammatory mediators (they increase inflammatory response) and anti-inflammatory ones. Under the influence of inflammatory mediators, changes in microcirculatory blood flow begin (vasospasm, arterial hyperemia, venous congestion, stasis) and exudation develops. Exudation is caused by an increase in the permeability of microvessels, its mechanisms are different. The composition of the exudate is determined by the cause of the inflammation and degree of tissue damage, the spectrum and amount of chemoattractants influence the type of exudate as well. The main types of exudates are serous, purulent, fibrinous, hemorrhagic, ichorous, catarrhal.

The second part of the lecture describes cellular events occurring in the focus of inflammation. The first cells migrating to the focus of inflammation are neutrophils, the second are accumulate monocytes (macrophages), and the final cells of inflammation are fibroblasts. This sequence is determined by the spectrum of chemoattractants which are presented in the focus of inflammation.

Neutrophil migration is initiated by tissue macrophages, which are activated upon tissue damage and begin to secrete cytokines, primarily IL-8 and IL-1. These cytokines ensure neutrophil adhesion to the vascular wall and their further chemotaxis along the gradient of these cytokines and other chemoattractants. There are several populations of neutrophils. Inflammation mainly involves high density neutrophils (mature cells) and low density neutrophils (immature cells, e.g. band forms). From a functional point of view, neutrophils are divided into pro-inflammatory (N1) and immunosuppressive (N2), the balance between these cells is very important for an adequate course of inflammation. Neutrophils begin the process of destroying the pathogen and tissue damage products. In addition to the long-known phagocytosis, this process is carried out with the help of neutrophil extracellular traps (NET), which consist of DNA, histones and lysosomal enzymes. Neutrophils in the focus of inflammation synthesize cytokines (IL-1, IL-6, TNFα, G-CSF and others), which stimulate the migration of monocytes and their differentiation into macrophages. Activated macrophages are divided into two groups: classic pro-inflammatory M1 and alternative anti-inflammatory M2. M1 are involved in the elimination of pathogen. They have powerful cytotoxic and antimicrobial activities. M2 macrophages produce anti-inflammatory cytokines (IL-10, TGFβ, etc.), growth factors, they stimulate angiogenesis, fibroblast proliferation processes and the formation of an extracellular matrix by fibroblasts. Fibroblasts, attracted by macrophage cytokines, complete the inflammatory process. They synthesize the basic substance of the connective tissue and provide the process of its organization. Dysregulation of cellular responses can underlie chronic inflammation.

Relevance. The classification of hereditary pathology largely determines the success of diagnosis and treatment of genetically determined diseases. The lecture presents the main criteria for the classification of hereditary pathology, adopted in genetics. The features of the distribution of genetic diseases according to the types of inheritance, the level of localization of mutations, according to organ and system principles, as well as according to the biochemical principle, are highlighted. Explanations are given on the expediency of grouping diseases according to the types of classification. The connection of classifications with the treatment and diagnosis of hereditary pathology is shown. For each group of classifications, examples of hereditary syndromes and diseases are given.

Conclusion. The classification of hereditary pathology is an important key to the diagnosis, treatment and prevention of hereditary diseases. At the moment, the OMIM Mendelian inheritance database contains information on more than 16,000 mutations of genes that determine hereditary syndromes (diseases), which is an order of magnitude more than the number of known nosological forms of somatic diseases. Classification helps the practitioner to understand the etiology, pathogenesis, clinical manifestations of hereditary diseases and is one of the most important diagnostic steps.

On April 29, 2023, Pogorelova Irina Gennadievna, Candidate of Medical Sciences, Dean of the Medical and Preventive Faculty of the State Medical University from 1996 to 2009, Associate Professor of the Department of Profile Hygiene Disciplines of the Irkutsk State Medical University, celebrated her anniversary.
Irina Gennadievna graduated from the sanitary and hygienic faculty of the Irkutsk State Medical Institute in 1986 and for more than 30 years her career has been inextricably linked with her alma mater.