Dear readers of the “Baikal Medical Journal”!
Here is the 4th issue of our magazine. We are summing up the results of our work for the year and are pleased with the high assessments of the public examination, which is carried out annually by the RSCI.

The review presents current data on heart disease in systemic amyloidosis. The article discusses variants of amyloi-dosis with common heart disease: AL-, ATTRwt- and ATTRv amyloidoses. Clinical signs of amyloid cardiomyopathy and extracardiac manifestations that allow one to suggest amyloidosis are described. Methods for diagnosing amyloid cardiomyopathy are presented.
Echocardiographic diagnostic characters include increased thickness of the left ventricular wall, atrioventricular valve, right ventricular wall, thickening of the interatrial septum, and also diastolic dysfunction, and decreased global longi-tudinal strain with relative preservation of apical longitudinal strain.
Magnetic resonance imaging reveals signs specific for amyloidosis: increased extracellular volume and diffuse suben-docardial or transmural delayed enhancement after gadolinium administration.
Scintigraphy using technetium-99m labeled compounds can confirm the diagnosis of ATTR cardiomyopathy. The diag-nosis of ATTR cardiomyopathy is only possible in combination with blood and urine tests to exclude the presence of a monoclonal protein. Screening for monoclonal protein includes three laboratory tests: determination of free light chains in blood serum, electrophoresis of serum protein and urine protein with immunofixation.
Indications for myocardial biopsy and the role of extracardiac tissue biopsy are discussed. Endomyocardial biopsy should be performed: a) in case of strong clinical suggestion of cardiac amyloidosis in a patient with monoclonal pro-tein; b) in case of strong clinical suggestion of cardiac amyloidosis, despite negative or equivocal scintigraphy result; c) if cardiac scintigraphy is not available.
The possibilities of pathogenetic therapy for ATTR- and AL amyloidosis, aimed at stopping or slowing amyloid deposi-tion in the heart, and symptomatic treatment are discussed.

Nonalcoholic fatty liver disease is a complex and multifactorial pathology associated with multiple epigenetic, genetic and environmental factors, and its pathogenesis is still not fully understood. Nonalcoholic fatty liver disease begins with simple steatosis and progresses to nonalcoholic steatohepatitis, which is characterized by signs of oxidative stress, increased lipid peroxidation activity, inflammation, fibrosis, and apoptosis. Antioxidant deficiency is important in the pathogenesis of nonalcoholic fatty liver disease, as it is they that cause the transition of steatosis to steatohepatitis in nonalcoholic fatty liver disease. Markers of antioxidant defense are used to assess disease progression and pathologic state. This article reviews several key biomarkers of antioxidant defense that can be investigated in clinical practice. 
Determination of these biomarkers in nonalcoholic fatty liver disease can be used for diagnostic purposes.

Sepsis is one of the significant problems in medicine for many decades. It is characterized by high levels of morbidity, mortality and high financial costs. The review is devoted to the cellular and molecular biological mechanisms of sepsis, including immune, biochemical changes, mitochondrial transformations, coagulopathy, neuroendocrine disorders, damage to the endoplasmic reticulum and a number of other processes that ultimately lead to multiple organ fail-ure. The article presents two directions of development of cellular and molecular biological changes in generalized inflammation, ending with a favorable or unfavorable outcome. Information on changes in the transport of cholesterol and polyunsaturated fatty acids in tissues against the background of septic processes is summarized. The mechanisms of reducing the concentration of cholesterol in tissues, the influence of hypocholesterolemia on the course of a gen-eralized inflammatory process and the development of such complications as Waterhouse – Friderichsen syndrome are discussed in detail. A concept of a chain of pathogenetic changes causing lethal outcome has been formed, and on its basis, methods for correcting metabolism in sepsis described in the literature (intravenous administration of reduced high-density lipoproteins, inhibition of proprotein convertase subtilisin kexin 9) are considered. For the first time, the concept of treating septic conditions with cholesterol in the composition of liposomes was proposed.

Urinary tract infections are among the most common bacterial infections. Currently, one of the main problems of therapy, as for the infections of other localizations, is the high level of antibiotic resistance. Timely prescribed and adequately selected antimicrobial therapy is the main factor determining the treatment outcome.
The aim of the study. To carry out dynamic analysis of the etiological structure of urinary tract microflora and to assess antibiotic resistance of the most significant uropathogens in patients of the Clinics of the Irkutsk State Medical University (Clinics of ISMU) in order to optimize the use of antimicrobial drugs in a multidisciplinary hospital.
Materials and methods. We analyzed bacterial strains (n = 2414) collected from urine of patients treated at the Clin-ics of ISMU from 2018 to 2022. Microbiological examination of urine was conducted in bacteriological laboratory of the Clinics of ISMU.
Results. During the study period, E. coli remained the main uropathogen. There has been an increase in antibiotic resistance of E. coli to the main antimicrobial agents which are traditionally used to treat urinary tract infections, including fluoroquinolones and third-generation cephalosporins. There is an increase in the frequency of detection of E. coli strains producing extended-spectrum b-lactamases from 5.4 % to 12.4 %. Meropenem and nitrofurantoin retain the greatest activity against E. coli.
Conclusion. The results of this study indicate the need to strengthen control over the use of antimicrobial agents in medical organizations, the importance of constant microbiological monitoring in order to identify the characteristics of local antibiotic resistance and update protocols for empirical treatment of urinary tract infections.

Background. Psycho-emotional stress in institutionalized children leads to significant tension in regulatory systems. 
Justification for using a complex of habilitation and rehabilitation measures aimed at reducing the stress factor and cre-ating conditions for “catch-up” development is an urgent problem.
The aim of the study. To create and to test the effectiveness of a complex of habilitation and rehabilitation measures aimed at reducing deprivation pressure and environmental stress.
Material and methods. The study included 114 children from children’s homes of Donetsk and Makeevka and 44 chil-dren from families aged 3 to 7 years. The complex of habilitation and rehabilitation measures included optimization of the daily routine, conditioning exercises, music, toy and fairy tale therapy, sessions of individual play and play in small groups of 2–3 people in a separate playroom, phototherapy with bright solar spectrum lamps, enriched sensory envi-ronment, increased physical activity, differentiated drug support with L-carnitine, glycine, hopantenic acid, magnesium and pyridoxine complex. Neuropsychic development was studied using the Denver Screening Test and the Formalized Card for the Study of Psychoneurological Functions according to I.A. Skvortsov and N.A. Ermolenko. The functions of regulatory systems were assessed by the level of cortisol and melatonin in saliva, and brain-derived neurotrophic factor in blood serum.
Conclusion. A comparison of the results of assessing the parameters of neuropsychic development confirmed the effec-tiveness of the proposed complex of habilitation and rehabilitation measures. Restoration of the function of regulatory systems was confirmed by normalization of the rhythms of cortisol and melatonin synthesis, as well as by a significant (3-fold) increase in the content of brain-derived neurotrophic factor in the blood serum in children of the main group.

Hypothyroidism is a significant aggravating factor for coronary heart disease (CHD). However, there are no practical recommendations for the management of this group to date. The main method of assessing the severity of coronary artery disease is a morphological assessment of the condition of the coronary arteries.
The aim. To carry out comparative assessment of clinical parameters, including the state of the coronary bed in patients with coronary artery disease with newly diagnosed (without hormone replacement therapy) and primary manifest hypothyroidism compared with patients with coronary artery disease without hypothyroidism.
Materials and methods. Two hundred and forty patients with CHD were examined. The study group included 90 patients with coronary heart disease and hypothyroidism, the comparison group consisted of 150 patients with coronary artery disease without thyroid pathology. A comprehensive examination of patients, including coronary angiography, was performed. The frequency of cases and characteristics of lesions of the coronary bed, the volume of interventions were assessed. The analysis of the obtained data was carried out in Statistica 10.0 (StatSoft Inc., USA).
Results. In the study group (CHD and hypothyroidism), a statistically significantly increased level of myoglobin, a change in lipid profile parameters in relation to patients with CHD without hypothyroidism was found. In the group of patients with coronary artery disease and hypothyroidism, a predominance of the frequency of multivessel lesions of the coronary bed was revealed. The volume of surgical interventions between the examined patients did not reveal significant differences.
Conclusion. Patients with coronary heart disease and hypothyroidism should be considered as a group of additional cardiovascular risk and require a more careful approach. It is possible to prescribe higher dosages of statins.

The high prevalence of overweight and obesity has become an international social problem. In Russia, every fourth woman and every fifth man is overweight.
Obesity is a consequence of an imbalance between intake and consumption of organic food. There are two distin-guishable causes of overeating - hereditary metabolic disorders and everyday hyperphagia. The main cause of obesity in modern humanity is everyday hyperphagia.
Obesity is an increase in the number and size of fat cells – adipocytes – in the human body. An increase in the number of cells is accompanied by an increase in the number of capillaries and cholesterol. To contain 1 kg of adipocytes, 100 km of capillaries are required, and 10 kg of adipocytes contain 25 g of cholesterol. In people with a high body mass index, each kilogram of fat requires 5.4 kcal/day. Obesity is a cause of hypertension, atherosclerosis, myocardial infarction, abnormal lipid levels, and type 2 diabetes.
Attention is paid to the role of acetyl-CoA, which in the catabolic cycle of proteins, triglycerols and glucose is a common intermediate that can participate in energy and plastic metabolism. The heterogeneity of liver cells has been shown in terms of their ability to store glycogen and participate in gluconeogenesis.
In the process of intake and consumption, food organics are first deposited in the form of glycogen, triglycerols and proteins. The consumption of deposited substances is controlled by the basal metabolism, thermogenesis and psy-chophysical activity of the individual. The share of basal metabolism accounts for 50–70 % of the total consumption of matter and energy. In this case, the expenditure of matter and energy on the basal metabolism occurs automati-cally. The primary task is the supply of oxygen, the work of the heart, the work of the kidneys and tens of hundreds of metabolic reactions are carried out without our conscious participation.
Under conditions of regular and frequent nutrition, the needs of basal metabolism are provided by glycogenolysis and glycolysis. Under conditions of fasting and physical activity, triglycerols become in demand, which, through hydrolysis and subsequent oxidation of fatty acids, are converted into acetyl-CoA and used in the tricarboxylic acid cycle. Under conditions of regular, excess nutrition and low physical activity, adipocyte triglycerols are in demand by the body only for basal metabolism.

The number of nosologic units of hereditary pathology is, according to Online Mendelian Inheritance in Man, about 16,000 syndromes (and their corresponding genes). Before starting diagnostics, it is necessary to make sure that the disease is genetically determined, using such signs as the familial and congenital nature of the pathology, progressive chronic course, multiplicity of pathological changes in organs and systems, resistance to known meth-ods of therapy. For effective diagnosis, it is necessary to use the assessment of minor and major developmental anomalies, as well as a syndromic approach. The syndromic approach is used to diagnose functional and anatomical syndromes that accompany hereditary diseases. This allows you to narrow the range of diseases to the use of labora-tory and instrumental research methods, and most accurately formulate a preliminary diagnosis for DNA diagnostics.
Diagnosis of hereditary pathology is a rather complex problem because the number of nosologic forms is large, and the final diagnosis is determined using expensive DNA diagnostics. In this regard, the possibility of using a syn-dromic approach in clinical diagnosis comes to the fore.