The summer issue of the Baikal Medical Journal has been published, which presents the results of the scientific work of our colleagues.

Relevance. Liver diseases are a serious social problem. The study of the pathogenetic mechanisms of the development of these diseases, the search for treatment methods that can radically improve the patient’s condition and stop the development of the disease is very relevant and in demand.

Aim: to conduct a literature review of currently known genetic factors in the etiology of non-alcoholic liver disease.

 Research results. The review presents the genetic aspects of the development of metabolically associated fatty liver disease (new name) or non-alcoholic fatty liver disease (common name). The leading syndromes accompanying the development of the disease are considered: asthenic syndrome, circadian rhythm disturbance syndrome ("circadian" syndrome), obstructive sleep apnea syndrome, cytolysis syndrome, insulin resistance syndrome, metabolic syndrome, pain syndrome, dyspeptic syndrome, irritable bowel syndrome, bacterial overgrowth syndrome growth, hepatomegaly and/or splenomegaly syndrome, fibrosis syndrome, polycystic ovary syndrome. The main comorbid conditions are covered: from the liver - hepatocellular carcinoma, cirrhosis of the liver, extrahepatic complications - obesity, type 2 diabetes mellitus, cardiovascular disorders - atherosclerosis, from the kidneys - chronic renal disease, etc. Data on genes affecting the development of diseases: PNPLA3, TM6SF2, MBOAT7, HSD17B13, GCKR, HFE, CP, INS, PPARG, CYP11A, AR, ENPP1, MTTP.

Conclusion. Studying the etiological causes (genetic polymorphisms) of non-alcoholic fatty liver disease is the main task towards solving the problems of effective patient care.

Relevance. Septoplasty is one of the most popular surgical operations in otolaryngology and plastic surgery.

The surgical technique of performing the operation is widely variable: endoscopic, endonasal and open operations are possible. Nasal septum repair methods can be divided into two categories: Killian septectomy and Cottle septoplasty. This surgical technique leads to typical complications, one of the most common being heavy bleeding. In patients with combined septoplasty and turbinoplasty, septal hematoma, hyposmia, prolonged healing due to infection, and adhesions are much more common.

The aim of the study was to analyze the development of complications after septoplasty.

Materials and methods. A retrospective analysis of clinical cases after septoplasty was performed for the period from 2022 to 2023 in the city of Irkutsk, Russian Federation. During this period, 34 patients met the study criteria. Surgical treatment included endonasal septoplasty with turbinoplasty.

Results. When constructing a logistic analysis, a significant predictor of bleeding was found to include an operation duration of more than 100 minutes (OR 53.9; 95 % CI 1.02; 941.0; p = 0.049). A model with good predictive value was obtained (AUC = 0.73). The sensitivity and specificity of the test are 50 % and 96.88 %, respectively. The overall confidence level is 94.12 %.

Conclusion. The information obtained about the predictors of postoperative bleeding after septoplasty allows us to predict these negative outcomes and prevent their development using active hemostatic procedures. Active use of tranexamic acid for patients at risk for postoperative bleeding will reduce the likelihood of this complication.

Relevance. Creatine phosphokinase is an enzyme that is often associated with muscle and myocardial damage. However, there may be other causes of elevated levels of this enzyme, such as stroke, hypothyroidism, paraneoplastic syndrome, as well as various pharmacological effects, including taking statins and the development of statin-associated muscle symptoms, the consequences of a previous coronavirus infection - COVID-19.

The aim of the work is to determine the cause of an increase in creatine phosphokinase in a patient who has suffered a coronavirus infection against the background of concomitant diseases, and to conduct a differential diagnosis of an increase in this enzyme.

Results. An analysis of the patient's medical history with a significant increase in the level of creatine phosphokinase was performed and a subsequent differential diagnosis was carried out to identify the main causes of this change. The study was carried out based on the general condition of the patient, as well as the results of general and biochemical blood tests (including the level of creatine phosphokinase and lactate dehydrogenase), and instrumental studies were also carried out, such as electroneuromyography, electrocardiography, echocardiography and ultrasound.

Ischemic cardiovascular disease and hypothyroidism were identified. However, the increase in creatine phosphokinase levels was not associated with statin use, since they were discontinued during observation, and the enzyme level increased over time. Other causes of increased creatine phosphokinase were also excluded, and the results indicate that the increase in the level of this enzyme is likely caused by a previous coronavirus infection with concomitant diseases.

Conclusion. The present study highlights the importance of a comprehensive approach to the differential diagnosis and treatment of elevated creatine phosphokinase levels in patients with comorbid pathology, as this can be a consequence of various factors, including infections, concomitant diseases and pharmacological influences.

Relevance. Misdiagnosis of retrosternal goiter occurs in 0,2 to 45 % of patients.

Case descriptions.  The authors present a case of recurrent cervical goiter from cervical exposure 34 years after the first surgical intervention. The reason for the goiter recurrence was considered as an inadequate previous surgery. In the presented case report, the node extended retrosternally to a depth of 8 cm, was fused to the paratracheal tissue, was supplied with blood from the right internal thoracic artery and was intimately adjacent to the aortic arch, which complicated surgical intervention from the classical approach. An atypical course of coronary heart disease was described as a manifestation of recurrent thyrotoxicosis. The lack of effect from conservative therapy for “cardiogenic” pathology could be due to the intrathoracic location of the goiter and the occurrence of subclinical thyrotoxicosis.

Surgical intervention is reasonable to perform in the extent of thyroidectomy with mandatory removal of intra-thoracic nodes with the elimination of all symptoms of thyrotoxicosis. A retrosternal goiter with a spread below the aortic arch can be removed from the cervical exposure.

Background. Official statistics on the incidence of listeriosis do not reflect the real spread of this infection, despite the increase in the reported case numbers in different regions of Russia.

The aim of this study is to draw attention to the diagnosis of listeriosis, especially in obstetric institutions.

Materials and methods. A descriptive  case study was conducted of 8 patents with listeriosis (7 adults, 1 child) registered in 2022-2023 in the Krasnoyarsk regional hospitals. Bacteriological testing was carried out in hospital laboratories where patients were treated. Identification of isolated bacteria was carried out using Maldi-Tof on a Vitec MS (BioMerieux, France) and Microflex (Bruker, Germany) mass spectrometer.

Case descriptions. All listeriosis cases were identified during the provision of emergency medical care to hospitalized patients. 5 women were admitted to the infectious diseases department after premature complicated childbearing, including after cesarean section (n=4). All children were born with congenital developmental defects of varying severity. The neonatal listeriosis was diagnosed in 4 cases, but only one is included in official statistics. One child died 2 days after birth. Two cases were not associated with pregnancy – acute appendicitis (n=1) and severe bacterial meningitis (n=1). The results of bacteriological examination were crucial for making a diagnosis and transferring patients to an infectious diseases department. Two types of listeria were isolated from the patients: Listeria monocytogenes and L. innocua. The incidence of listeriosis was 0.15 per 100 thousand population of the region and 0.84-0.98 per 1000 postpartum women and patients in the infectious diseases department. The circumstances and time of infection were not precisely established in any of the cases.

Conclusions. The described cases confirm the relevance of modern laboratory methods  implementation and improving infection control in obstetric medical institutions and when providing medical care to immunocompromised patients.

Relevance. Severe complications that cystic fibrosis causes require comprehensive study and prevention. Consideration of rare clinical variants of the disease is an important task for understanding the clinical manifestations of cystic fibrosis.

Aim. To present a clinical case of congenital meconium peritonitis, small intestinal volvulus and necrosis of meconium pseudocyst of the abdominal cavity, which developed against the background of cystic fibrosis.

Results. A clinical case of cystic fibrosis was considered, the cause of which was a combination of pathogenic mutations in the CFTR gene (mutation delta F508; p.Phe508 and CFTRdele2,3). Against this background, a meconium pseudocyst, meconium peritonitis and volvulus of the small intestine were formed.

Conclusion. Doctors need to be wary of hereditary pathology if patients have congenital malformations.

Relevance. Spinal cord tumors account for 1,4-10,0 % of all tumors of the central nervous system. Among the tumors of the spinal cord, the incidence of tumors of the "hourglass" type (with intracanal/paravertebral) is 13-14 %. The incidence of neurinomas in the structure of primary extramedullary tumors reaches 40 % with the most frequent localization in the thoracic spine.

Aim: to present a clinical case of surgical treatment of paravertebral neurinoma with transthoracic extrapleural access, to show its safety and advantage.

Case descriptions. The paper describes a rare clinical case of surgical treatment of thoracic spine neurinoma. Before surgery, a puncture biopsy was performed under navigation using computed tomography. A total removal of the tumor from the transthoracic extrapleural access was performed. The technical nuances of the intervention are described and the operational possibilities of transthoracic extrapleural access in the removal of tumors of the posterior mediastinum of neurogenic origin are demonstrated. The experience of using transthoracic extrapleural access has shown its effectiveness in removing thoracic spine neurinomas. Further, the article provides a comparative analysis of various approaches for removing neurinomas of posterior mediastinal tumors of neurogenic origin. After 6 months, the patient underwent radiofrequency neuroablation of the intercostal nerve due to persistent post-thoracotomy pain syndrome.

Conclusion. This clinical observation demonstrates the advantages of transthoracic extrapleural access, which can be successfully used in the removal of paravertebral neurinomas. Transthoracic extrapleural access shows advantages in terms of reducing intrapleural complications: pleurisy, atelectasis, pneumothorax, adhesive process in the pleural cavity.

Relevance. The renin-angiotensin system is today one of the oldest and most studied peptide cascades. Understanding the operation of this system is an urgent task for study in medical higher education institutions. The renin-angiotensin system is an important regulatory system that supports the metabolism and functioning of many organs, including blood vessels and the myocardium. Since cardiovascular diseases are the main cause of mortality, the study of positive and negative mechanisms of regulation of the cardiovascular system is an urgent task at the present stage.

Aim. Consider modern ideas about the renin-angiotensin system and its role in the regulation of homeostasis.

Results. The lecture discusses the classical and tissue renin-angiotensin system, the main angiotensin metabolites, the pathways of their formation and the enzymes that catalyze these transformations. The effects realized by angiotensins through various receptors are shown. The modern point of view on the levels of organization of the renin-angiotensin system in the body and the relationship of various angiotensin antagonists with each other is considered.

Conclusion. The renin-angiotensin system is one of the most complex systems of hormonal regulation, including several organs that interact to regulate many body functions. The effects of angiotensins are complex and often opposite. An imbalance in the regulation of angiotensin homeostasis leads to metabolic disorders of organs and tissues and manifests itself in pathologies in which inflammatory, hypertrophic and fibrotic phenomena are common, and are also associated with the development of chronic diseases affecting various organs and tissues of the body.

The head of the Department of Human Anatomy, Operative Surgery and Forensic Medicine of Irkutsk State Medical University, Doctor of Medical Sciences, Professor Tamara Ismailovna Shalina turned 70 years old. Tamara Ismailovna was born on May 5, 1954 in Cherkessk, Stavropol Territory. After graduating from school, she entered medical school and graduated with honors in 1975. Having worked as a paramedic in a medical and physical education clinic and in an anti-tuberculosis clinic, she realized that medicine was her calling and that she was most interested in preventive medicine and scientific research. Therefore, she decided to continue her studies and in 1979 she entered the sanitary and hygienic faculty of the Irkutsk State Medical Institute. After graduating from the institute in 1985, she was invited to the Department of Human Anatomy as an assistant, where she works to the present day.

Teams of the departments of human anatomy, operative surgery and forensic medicine, histology, embryology, cytology, normal physiology, university staff and students warmly congratulate Tamara Ismailovna on her 70th birthday, wishing her good health, family well-being and further achievements in her career.