Dear readers of the "Baikal Medical Journal"!
The spring issue of the "Baikal Medical Journal" has been published, in which we have published the latest achievements of our colleagues from different regions of Russia and the Irkutsk State Medical University.

Background. Lupus nephritis is one of the most severe manifestations of systemic lupus erythematosus, which negatively affects the prognosis of the disease. In case of delayed diagnosis and treatment, it leads to unfavorable outcomes of renal survival.

Aim. Determine the clinical and morphological characteristics and analyze the effectiveness of treatment of patients with lupus nephritis in the Irkutsk Nephrological Clinic.

Material and methods. Clinical and morphological characteristics of patients with lupus glomerulonephritis were carried out in the general group of patients (n = 40). The diagnosis of systemic lupus erythematosus was established using the criteria of EULAR/ACR, 2019. The diagnosis of lupus glomerulonephritis was based on the detection of characteristic clinical and laboratory data and the results of morphological examination of renal tissue. The effectiveness of standard induction therapy was evaluated in a sample group of patients (n = 20). Clinical symptoms and laboratory parameters were compared before and after 3 months of induction therapy with corticosteroids and cyclophosphamide.

Results. Clinical and laboratory symptoms of lupus nephritis are characterized by nephrotic syndrome (in 70 % of patients), hematuria (100 %), arterial hypertension (75 %); almost half of patients have decreased renal function. Morphological examination of renal tissue reveals the prevalence of lupus nephritis of class IV (66.7 %), including with half-moons in 58.3 % of patients, with “full house" (13 %) and with acute tubular necrosis (47.8 %). An analysis of the effectiveness of induction therapy in the first 3 months found a significant decrease in proteinuria and improvement in renal function only in patients without half moons or with half moons in less than 50 % of glomeruli compared with patients with half moons in more than 50 % of glomeruli.

Conclusion. Patients with systemic lupus erythematosus and renal impairment most often develop lupus glomerulonephritis of class IV. The predominant clinical manifestation of lupus nephritis class IV is nephrotic syndrome. Half of the patients have renal insufficiency. To improve the effectiveness of treatment of patients with rapidly progressing semilunar glomerulonephritis, it is advisable to use targeted immunosuppressants of a new generation.

Background. One of the most common arrhythmias in clinical practice is atrial fibrillation. Restoration of sinus rhythm is preferable for this type of arrhythmia. Radiofrequency ablation improves the prognosis and quality of life of the patient. Simultaneous coronary revascularization in persistent atrial fibrillation allows achieving the expected result. However, the simultaneous performance of these operations can increase the risk of postoperative complications, including recurrence of arrhythmia. Outpatient management of such patients is difficult, since there are no clear antiarrhythmic therapy regimens depending on the patient's comorbid status.

Case report. This article presents a clinical case of postoperative management of a 62-year-old patient after radiofrequency ablation of arrhythmogenic zones and resection of the left atrial appendage for persistent atrial fibrillation, combined with coronary artery bypass grafting using a single-channel electrocardiogram monitor in a smartphone case.

Conclusion. Remote telemetric monitoring of the electrocardiogram in the CardioQVARK smartphone case is easy to use and allows you to obtain additional information about the functioning of the cardiovascular system. Early detection of arrhythmia recurrence allows the doctor to optimize the antiarrhythmic therapy, improve the prognosis of the disease and the quality of life of patients. The use of modern non-invasive telemetric monitoring of the electrocardiogram is a promising direction in the development of medicine. It can improve the quality of medical care and increase the effectiveness of treatment for patients with cardiovascular diseases. 

Background. The Wolf-Parkinson-White phenomenon is an electrocardiographic phenomenon caused by accessory atrioventricular pathway with ventricular preexcitation. The Wolff-Parkinson-White pattern can mimic myocardial infarction and be the cause of its overdiagnosis. At the same time, it can mask the true myocardial infarction.

The aim.  To present the diagnostic algorithm for suspected myocardial infarction in a patient with Wolf-Parkinson-White phenomenon.

Case report. A clinical case demonstrates the difficulties of diagnosis of myocardial infarction in a patient with Wolf-Parkinson-White phenomenon. A 47-year-old patient presented with chest pain radiating to his left arm. Electrocardiogram revealed a negative delta wave in leads II, III, and avF with ST segment elevation in these leads. There were positive delta waves and ST depressions and T inversions in lead I, aVL, V1-V6. Conclusion about inferior myocardial infarction with ST elevation was made. Thrombolytic therapy was performed. There was no dynamic on the electrocardiograms. The patient was transported to the Percutaneous Coronary Intervention center. Coronary angiography did not show any coronary artery stenosis. The troponin I level was normal and repeat troponin test was normal too. Echocardiography did not reveal disturbance of local contractility.

The results of the examination made it possible to exclude a myocardial infarction in the patient with Wolf-Parkinson-White phenomenon. Electrocardiography indicates a left-sided posteroseptal accessory pathway. The patient has a Wolf-Parkinson-White phenomenon, as there are no attacks of paroxysmal tachycardia.

Conclusion. This case illustrates the difficulties of diagnosis of myocardial infarction in a patient with the Wolf-Parkinson-White phenomenon and importance of assessment ECG dynamic, troponin, coronarography and echocardiography.

Background. The combination of acute surgical pathology and myocardial infarction is a challenge to emergent surgeons. These patients are in high surgical risk groups. Various tactical options are described for regarding the priorities of therapeutic interventions. There are no clinical standards for the treatment of a combination of myocardial infarction and strangulated hernia. Considering that both pathologies require urgent care equally, it is wise to perform myocardial revascularization (coronary artery stenting) and herniation simultaneously. We found no references in the literature concerning similar approach in the discussed pathology.

Case report. We report a rare case of a 46-year-old male presented with ischemic disease complicated by Q-infarction and a strangulated inguinal hernia.  The two pathologies developed with a few minutes difference. Myocardial infarction was verified with electrocardiography and troponin test (0,440 mcg/ml). Ultrasound examination of the abdomen showed intestinal obstruction and inguinal hernia on the left with signs of strangulation. The patient underwent almost simultaneous myocardial revascularization of the right coronary artery system and inguinal herniation following systemic thrombolytic therapy and under the ongoing antiplatelet therapy. Timely stenting of the infarct-dependent vessel improved cardiac function and stopped the ischemic area expansion with subsequent myocardial necrosis. Herniation in its turn prevented necrosis of the strangulated loop of the small intestine which otherwise should be resected. The patient was discharged on the 11th day in a satisfactory condition.

Conclusion. A hybrid approach and sequence of emergency care (myocardial revascularization and hernia repair), careful hemostasis against the background of antiplatelet therapy prevent further complications.

Background. Cholelithiasis and its complications, choledocholithiasis in particular, accompanied by mechanical jaundice, are still prominent in the structure of abdominal pathology. Minimally invasive transluminal cholangiolithotripsy is the primary method of restoring the bile outflow. However, when extracting large concrements, the Dormia basket can obstruct the choledochus, resulting in decubitus of the duct wall, bleeding, acute pancreatitis, etc. Therefore, this complication requires urgent open surgery: choledocholithotomy, cholecystectomy, drainage of the bile duct.

Aim. We report the case of choledochus obstruction by an extraction basket with the trapped large calculus and the subsequent management of this complication.

Materials and methods. An 87-year-old female presented with cholelithiasis and obstructive jaundice after the failed procedure of endoscopic lithotripsy. The intervention was complicated with obstruction of the hepaticocholedochus with large calculus and Dormia basket, and with traction wire rupture.

Results. After preoperative procedure, choledocholithotripsy was performed successfully, and the foreign body was removed. The patient was discharged with recovery.

Conclusion. The impaction of Dormia basket in the bile duct is a serious complication of transluminal lithotripsy, which is highly likely to be complicated with perforation of the choledochus, acute pancreatitis, and other bad outcomes. Urgent open deobstruction of the bile duct prevents these complications.

Background. Massive pulmonary hemorrhage (grade IIIA-IVB according to the classification of Grigoriev) is a difficult problem for both ambulance teams and specialized hospitals. The mortality rates 50 % or more. Death at the top of hemorrhagic attack follows mainly from flooding of the respiratory tract with blood and asphyxia. Malformation of the lung bloodstream (angiodysplasia, angiomatosis) as the cause of pulmonary hemorrhage is a real challenge for treatment because of multiple sources of bleeding. Effective endovascular hemostasis and prevention of recurrent pulmonary hemorrhage are possible, provided that all blood vessels supplying the pathological area are occluded.

Case description. The article presents a case report of recurrent massive pulmonary hemorrhage that debuted in a 40-year-old woman with no previous pulmonary history. Inpatient treatment included tracheobronchoscopy, bronchial occlusion of the bleeding lung, obstruction of the contralateral bronchial tree, X-ray endovascular occlusion of the bronchial arteries. Pulmonary hemorrhage recurred. Repeated occlusion of the systemic lung arteries arrested the bleeding for a period. Results. Induced emergency pneumonectomy was performed at the height of recurrent pulmonary hemorrhage. Death occurred on the 6th postoperative day because of advancing nosocomial pneumonia.

Conclusion. The above case report demonstrates the difficulties of managing massive pulmonary hemorrhage in rare lung vascular malformations and multiple sources of bleeding. Occlusion of the lower diaphragmatic artery, one of the major bleeding arterial collectors, failed, which caused asphyxiating hemorrhage. Surgically successful emergency pneumonectomy resulted in death due to nosocomial pneumonia of a single lung.

Background. The spinal cord is an important part of the central nervous system, and its functions are closely related to maintaining the functioning of organs and ensuring interaction between body’s organ systems. The spinal cord plays a major role in the transmission of information between effector organs and the brain, being a conductor of impulses. Knowledge of the morphological organization of the spinal cord is necessary for students of medical universities, neurologists, and neuroscientists, since the functions performed by the spinal cord are closely related to the preservation of its anatomical structures. Spinal cord damage due to infectious and non-infectious factors is the cause of the development of many pathological conditions and diseases of the central nervous system (CNS). More than 15 million people have spinal cord injuries, worldwide, which entails not only medical, but also significant socio-economic consequences. Also, a clear understanding of the morphological features of the spinal cord will prevent its damage during a many manipulations.

The aim. To study the features of the morphological organization of the spinal cord, relationship of changes in anatomical structures with some pathological conditions and diseases.

Results. The lecture examines classical and modern ideas about the morphological organization of the spinal cord. The influence of changes and damages of various structures of the spinal cord on the development of pathological conditions and their manifestations is explored. In turn, the presence of certain symptoms suggests and diagnoses the level of spinal cord damage.

Conclusion. The morphological organization of the spinal cord and its features must be taken into account in the diagnosis, treatment and prognosis of certain neurological diseases. Damage to the structures of the spinal cord leads to serious consequences, such as impaired sensitivity, movement, and other organ functions.

Background. Facial pain, or prosopalgia, is a multifactorial group of diseases of both the central and peripheral nervous systems. The peculiarity of clinical manifestations of facial pain is the complex anatomical and physiological organization of the facial region, characterized by the diversity and branching of nerves, ganglia, vascular bundles, as well as joint and muscular structures.

Pathologic processes in the facial region can have a mixed character, and the neurotic component is often layered on any of their manifestations, which is of great importance in the treatment of prosopalgia of different nature.

As a consequence, facial pain is the subject of study of specialists of different clinical profiles - otorhinolaryngologists, dentists, neurologists, ophthalmologists, psychiatrists.

One of the most common is the pathology of the trigeminal nerve, while various pathogenetic variants of pain can be present: nociceptive, neuropathic or dysfunctional (nociplastic). However, due to the structural and functional features of the face, combinations of different pain phenomena can be observed in one nosological form. Pain manifestations can be realized by various mechanisms: compression-ischemic, inflammatory, mechanical, reflex and somatogenic. Conclusion. Using generalized knowledge of anatomy, physiology and pathology, it is possible to more reasonably use modern diagnostic methods to establish the correct diagnosis, as well as apply treatment methods based on the canons of evidence-based medicine.

Background. Hereditary pathology has a large proportion of morbidity in modern humans. Therefore, the search for methods for treating hereditary pathology is a particularly urgent problem. Currently, there are theoretical foundations and practical solutions for the development of methods for the etiological treatment of hereditary pathology. In this regard, genome editing methods are the most promising methods for treating hereditary pathology.

The lecture discusses the historical aspects of the development of scientific thought in the field of genome editing, technological systems, protocols and stages of developing treatments for hereditary pathology using genome editing.

Conclusion. Genome editing is one of the most promising methods for treating hereditary pathology, so doctors' awareness of this issue will allow them to use the developments of molecular biology in the future to treat human genetic diseases.