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Aim: To evaluate the diagnostic value of ultrasound (US) parameters and indices for assessing the active inflammatory bowel diseases (IBD).

Materials and methods: The study included 115 patients with IBD, 41 (36%) patients were with ulcerative colitis (UC) and 74 (64%) - with Crohn's disease (CD). Transabdominal US examination of the intestine was performed on Sonoscape S2N, with a bowel wall thickness (BWT) of 3 mm considered the norm. To assess activity in UC, the Milan Ultrasound Criteria (MUC) score was used, and in CD - International Bowel Ultrasound Segmental Activity Score (IBUS-SAS).

Results: In active UC BWT (5.91 [4.87; 6.95] mm) was greater than in remission (2.9 [2.6; 3.1] mm; p = 0.003). For active UC diagnosis BWT greater than 3 mm had sensitivity (Se) of 90.5% and specificity (Sp) of 70.6%. The MUC in exacerbation (9 [7.88; 11.8]) was higher than in remission (4.2 [3.64; 4.9]; p < 0.001). In 31 (89%) patients in exacerbation, the MUC was higher than 6.2 (Se 88.9%, Sp 87.5%), and in 34 (97%) at a threshold of 5.18 (Se 96.3%, Sp 87.5%). In active CD, BWT (4.9 [3.8; 6.6] mm) was greater than in remission (3.18 [2.6; 3.5]; p = 0.0001), with Se 87.0%, Sp 71.4%. The IBUS-SAS in active CD (46.8 [27; 71.5]) was higher than the remission (12.6 [11.2; 30.2]; p = 0.001). At a threshold of 37.5, the IBUS-SAS had Se 92.6%, Sp 61.5%, and at 45.2, Se 92.6%, Sp 87.2%.

Conclusion: US imaging is a useful and effective tool for assessing IBD activity; a threshold value of the MUC score of 5.18 and IBUS-SAS of 45.2 suggests better diagnostic value for differentiating between exacerbation and remission.

Background: The article presents the results of a prospective open-label comparative interventional study of the efficacy and safety of high-dose dual therapy (HDDT) for eradicating Helicobacter pylori infection.

Aim: To evaluate the efficacy and safety of HDDT of the H. pylori eradication regimen, as well as the possible increase in the efficacy of this regimen with the addition of rebamipide.

Materials and methods: All patients with verified H. pylori infection were randomized into three groups depending on the treatment regimen. The Era-AmIPP group (n = 24) received HDDT (esomeprazole 120 mg/day and amoxicillin 3000 mg/day) for 14 days. The Era-RebAmIPP group (n = 121) received HDDT with rebamipide 300 mg/day for 14 days. The comparison group (n = 101) received conventional triple eradication therapy enhanced with bismuth tripotassium dicitrate for 14 days. The effectiveness of eradication was evaluated at 4-6 weeks after the end of therapy. Particular attention was paid to assessing the safety of therapy, the incidence of adverse events, and treatment adherence.

Results: The study included 246 patients. Low efficacy (87.5% [95% confidence interval [CI] 69.0-95.7]) of HDDT was shown. Adding rebamipide 300 mg/day to HDDT increased the eradication rate to 96.3% (95% CI 90.9-98.6). The efficacy of the Era-RebAmIPP regimen in patients previously treated with conventional eradication regimens was 91.7% (95% CI 64.6-98.5). Adverse events were reported in 37.5% (95% CI 21.2-57.3) patients in the Era-AmIPP group, 19.8% (95% CI 13.7-27.8) in the Era-RebAmIPP group, and 31.3% (95% CI 22.9-41.1) in the comparison group (p = 0.07).

Conclusion: The efficacy of the Era-RebAmIPP regimen is comparable to conventional triple therapy with bismuth. To assess the effectiveness of this regimen, larger-scale studies are required in various regions of our country.

Aim: To develop a treatment strategy based on the analysis of clinical manifestations and the results of morphofunctional diagnostics for patients with gastroesophageal reflux disease (GERD) aimed at preventing the development and progression of intestinal metaplasia (IM) of the esophageal epithelium.

Materials and methods: The study included 50 subjects diagnosed with GERD. After esophagogastroduodenoscopy with biopsy and subsequent morphological examination of the esophageal mucosa, two groups were formed: patients with GERD complicated by IM, also known as Barrett's esophagus (n = 19), patients with GERD without IM (n = 31). All participants underwent high-resolution esophageal manometry and 24-hour impedance pH monitoring.

Results: The study found that in patients with GERD complicated by IM, complaints of intense heartburn and difficulty swallowing occurred more often than in patients with GERD without IM. According to manometry, the resting pressure of the lower esophageal sphincter in patients with GERD and IM (15.1 [1.3; 36.4] mmHg) was lower than in patients with GERD without IM (20.3 [5.5; 42.1] mmHg). This difference was statistically significant (p = 0.002). In patients with GERD and IM, esophageal motility is less effective; this was translated in a decrease in the distal contractile integral of the esophagus to 276.5 [0.2; 567.7] mmHg × s × cm, while in patients with GERD without IM, it was much higher: 942.5 [47.3; 3759.7] mmHg × s × cm. Difficulties in swallowing were associated with a reduced effectiveness of esophageal motility. In patients with GERD complicated by IM, more acid gastroesophageal refluxes were observed compared to patients without IM (72.5 [53.5; 91.5] vs 54.2 [29.9; 78.3]; p = 0.036). They also have a greater percentage of time with pH < 4.0 in the esophagus (14.5 [9.7; 19.3] vs 10.3 [5.6; 14.9]; p = 0.028) and higher DeMeester index values (35.4 [1.9; 114.5] vs 15.1 [0.2; 47.7]; p = 0.004).

Conclusion: GERD is a multifactorial disease with a primary impairment of the motor function of the upper gastrointestinal tract. The acidic reflux may affect the development of the intestinal type of epithelial metaplasia.

Background: Treatment of immune thrombotic thrombocytopenic purpura (iTTP) includes plasma exchange (PEX) and immunosuppression (glucocorticoids and rituximab). The addition of caplacizumab to therapy has improved treatment outcomes in iTTP. However, the available therapies focus on the duration of drug administration and clinical response rather than ADAMTS13 activity.

Aim: To evaluate the efficacy of therapy for iTTP targeting ADAMTS13 activity.

Materials and methods: Treatment of patients with iTTP was started with PEX, prednisolone (1 mg/kg) and caplacizumab (10 mg/day). PEX was discontinued after an increase of platelet count > 150×10⁹/L. Only after PEX cessation treatment with rituximab (375 mg/m² weekly) was started. Caplacizumab was discontinued when partial remission (ADAMTS13 > 20%) was achieved. Rituximab and glucocorticoids were discontinued when complete remission (ADAMTS13 > 40%) was achieved. Platelet count, schistocyte count, haemoglobin, haptoglobin, lactate dehydrogenase activity, ADAMTS13, ADAMTS13 inhibitor titre, number of PEX, plasma volume replaced, time to increase platelet count > 150×10⁹/L, achievement of partial and complete remission were analyzed. Data are presented as median and interquartile range.

Results: From 2021 to 2025, the diagnosis of TTP was confirmed in 102 patients. 35 patients were included in the study. Platelet counts > 150×10⁹/L were achieved after 4 (3-5) PEX procedures in 4 (3-4.5) days. In total, 11 395 (7241-16 343) ml of plasma were exchanged. Partial remission was achieved in 100% of patients, the duration of caplacizumab therapy was 23 (12-30) days. Rituximab was administered from 4 to 8 times (median 4), complete remission was achieved in 33 out of 35 patients, 2 patients achieved only partial remission, they were treated with bortezomib and 1 with anti-CD38 monoclonal antibody. The probability of complete remission was 97.1%.

Conclusion: The duration of therapy with caplacizumab, rituximab and glucocorticoids in patients with iTTP should be determined by the achievement of target ADAMTS13 activity.

Aim: To evaluate the clinical and prognostic significance of atrial functional mitral regurgitation (AFMR) in patients with heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) on the background of optimal drug therapy.

Materials and methods: The retrospective study included 150 patients (age 75.5 ± 9.9 years, 54% men) with HFpEF with AF and AFMR on the background of optimal drug therapy. Clinical and demographic characteristics (including the scale of assessment of the clinical condition), laboratory and instrumental diagnostic results, and drug therapy were evaluated. MR was assessed as minor, moderate, or severe using a multiparametric approach, including an assessment of the effective area of the regurgitation hole and the MR fraction. The effect of AFMR on rehospitalization for HF, combined endpoint (CE) was studied [cardiovascular death (CVD) and rehospitalization] during the follow-up period of 589 (217-1039) days.

Results: Eighty (53.3%) patients had moderate AFMR, and 23 (15.3%) had severe AFMR. These patients had lower SBP and DBP values (p = 0.014), and permanent AF was more common among them (p = 0.025) compared with patients with minor MR. Independent predictors of moderate/severe AFMR were the constant form of AF (OR 3.3 [1.4-8.0]; p = 0.007), end-systolic left ventricular distance (OR 3.0 [1.4-6.5]; p = 0.006), taking antiplatelet agents (OR 0.11 [0.02-0.70]; p = 0.020). The frequency of outcomes in the general group was 46.7% for CE, 34.0% for rehospitalization for HF, and 14.0% for CVD. The predictors of CE were moderate/severe FMR (HR 2.6 [1.4-4.9]; p = 0.002), scores on the scale of assessment of the clinical condition (HR 1.14 [1.04-1.25]; p = 0.003); severe FMR (HR 4.1 [1.7-10.2]; p = 0.002), moderate FMR (HR 2.7 [1.2-5.8]; p = 0.013), creatinine level (HR 0.990 [0.980-1,000]; p = 0.040).

Conclusion: Despite the limitations, the importance of AFMR as a factor influencing clinical outcomes in patients with HFpEF and AF has been demonstrated. The present study highlights the need for further investigation of this condition and the development of personalized patient management strategies.

Type 2 diabetes mellitus is one of the most common chronic diseases, which is a risk factor for a wide range of complications. The introduction of an approach consisting of early administration of combination hypoglycemic therapy into clinical practice makes it relevant to study available fixed-dose combinations of hypoglycemic drugs. Alogliptin and pioglitazone are of interest in terms of their complex effect on the patient's organism. The purpose of this review is to assess the advantages of the combination of alogliptin and pioglitazone based on an analysis of published data on the pharmacodynamics, pharmacokinetics, efficacy and safety of these drugs.

Aim: To study the ability and significance of detecting liver steatosis during chest computed tomography (CT) in patients with viral pneumonia.

Materials and methods: A prospective cohort study included 100 patients over the age of 18 who were hospitalized with an established diagnosis of viral pneumonia. To CT detection significant liver steatosis (more than 33%), several approaches were used: liver density less than 40 HU; decrease in liver density by at least 10 HU less than the spleen; the ratio of decrease in liver density to the spleen is less than 0.9.

Results: According to CT data 2 groups were identified: 25 patients with existing liver steatosis and metabolically associated fatty liver disease, and 74 patients of the control group without signs of significant steatosis, оne patient was excluded due to alcohol abuse. There was a significant difference in the study of liver density (31.68 ± 10.67 and 54.44 ± 5.95; p < 0.001), the ratio of decrease in liver density to spleen density (0.66 ± 0.22 and 1.16 ± 0.13; p < 0.001), as well as a decrease in liver density relative to the spleen (16.30 ± 10.38 and -7.26 ± 6.10; p < 0.001). In the steatosis group, a more severe course of pneumonia was noted (p = 0.041). The incidence of deterioration according to CT was comparable in both groups: 19 (76%) and 45 (60.8%); p = 0.169, although its severity was higher in the group with steatosis (p = 0.012). Patients from the steatosis group were significantly more often prescribed biological (88.0 and 39.19%; p < 0.001) and antibacterial therapy (68.0 and 40.54%; p = 0.017).

Conclusion: The use of assessment of liver steatosis according to CT data simultaneously with the study of the underlying disease can become an important diagnostic step determining the prognosis of the course of the disease, as well as a tool for risk stratification in patients with metabolically associated fatty liver disease.

The article highlights the main events, discoveries and principles of organizing medical care at the front and in the rear during the Great Patriotic War of 1941-1945. The main aspects of the battlefield medical doctrine, the system of stepwise casualty care, the complex of anti-epidemic measures, the care of motherhood and childhood, the role of outstanding scientists and health care organizers in the victory over fascism are considered.

Idiopathic recurrent pericarditis is a rare pathology characterised by recurrent inflammation in the cardiac cavity. Treatment of recurrent pericarditis is empirical and based on the use of drugs with anti-inflammatory properties. First-line drugs are non-steroidal anti-inflammatory drugs and colchicine, second-line drugs are glucocorticosteroids. This is associated with the development of undesirable side effects, which makes it impossible to continue therapy in a number of patients. This article presents two clinical cases, describes the course of the disease and the development of complications at different stages. This article demonstrates the complexity of selecting the optimal therapy in real clinical practice.