Nuru Bayramov

Introduction: Hydatid disease rarely involves the adrenal region, particularly in pediatric patients, making diagnosis and surgical management challenging due to the complex anatomical relationships in the subdiaphragmatic space. This case highlights the feasibility of laparoscopic management of a hydatid cyst in an unusual subdiaphragmatic location, adjacent to the adrenal gland, in a child. Presentation of the case: A 13-year-old boy from an endemic region presented with intermittent epigastric pain without systemic symptoms. Ultrasonography demonstrated a cystic lesion beneath the left hemidiaphragm, and contrast-enhanced computed tomography revealed a 60–63 mm thick-walled cyst between the stomach and spleen, closely adherent to the left crus of the diaphragm and the left adrenal gland. The patient underwent laparoscopic partial pericystectomy with preservation of the adrenal gland. Histopathological examination confirmed hydatid disease. The postoperative course was uneventful, and no clinical or ultrasonographic evidence of recurrence was detected during the 3-month follow-up period. Clinical discussion: Hydatid cysts adjacent to the adrenal gland are rare in pediatric patients and present diagnostic and surgical challenges due to their complex anatomical location. This case demonstrates the technical feasibility of laparoscopic adrenal-sparing partial pericystectomy in a carefully selected pediatric patient, when meticulous surgical technique is applied. Conclusion: In selected pediatric patients with hydatid cysts in unusual subdiaphragmatic locations, laparoscopic partial pericystectomy may provide a feasible organ-preserving treatment option. Longer follow-up is required to assess long-term outcomes and recurrence.

Postoperative duodenal fistula is a rare but serious complication after cholecystectomy and nephrectomy. A case of a 58-year-old woman with chronic calculous cholecystitis and right-sided nephrolithiasis who developed a postoperative duodenal fistula with retroperitoneal abscess is presented. Initial conservative management and percutaneous drainage were performed. Endoscopic closure using TTS endoclips and an endoloop was performed after five months of persistent fistula. Complete fistula closure was achieved, confirmed by follow-up endoscopy and CT scan. Endoscopic closure with TTS endoclips and an endoloop is an effective, minimally invasive option for small chronic duodenal fistulas. Over-the-scope clips (OTSCs) were not used due to the small fistula size and well-formed granulation tissue, which allowed for successful closure with conventional endoscopic tools.

Variations in hepatic arterial anatomy are clinically significant in upper abdominal surgery. A left hepatic artery (LHA) arising from the left gastric art

Hypoxia-inducible factors (HIFs) are key transcription factors that regulate cellular adaptation to low oxygen conditions. In recent years, their role in the pathogenesis of liver diseases has gained increasing attention. In this study, the role of HIFs in fibrogenesis and disease progression was evaluated based on a clinical case with impaired liver function. The findings suggest that elevated HIF levels are associated with activation of hypoxia-related pathways and enhanced fibrogenic processes in the liver. This case suggests that elevated serum HIF levels may reflect active fibrogenesis and disease progression in liver cirrhosis.

Schwartz–Jampel syndrome (SJS) is a rare autosomal recessive disorder and is divided into two types: type 1 related to the HSPG2 gene, and type 2 associated with mutations in the LIFR gene. Classically, type 2 is characterized by severe course and lethality in the neonatal period. In our observation, two clinical cases of SJS type 1 and type 2 were compared. The type 2 patient suffered from neonatal hypotonia, seizures, and developmental delay, and whole-exome sequencing confirmed a homozygous mutation in the LIFR gene. Contrary to expectations, the patient survived up to the age of 3 and acquired certain motor skills. In the type 1 patient, long-term progression was accompanied by severe orthopedic complications, contractures, and kyphoscoliosis, while intellectual ability was preserved. These cases show that type 2 may not always be lethal, whereas type 1 can lead to severe orthopedic disability. The results emphasize the importance of molecular genetic testing and prenatal diagnostics in the detection of rare diseases.

The object of the study is the clinical decision-making process for selecting of hepatocellular carcinoma (HCC) treatment method based on the patient's medical data. The process of the HCC treatment method selection remains poorly formalized and is characterized by multi-criteria and the presence of numerous clinical situations, for each of which it is necessary to promptly identify the most accurate therapeutic solution. This study develops an intelligent medical decision support system for HCC treatment method selection based on knowledge applicable in clinical practice. It offers architectural and functional principles of the intelligent decision support system, classifying clinical situations by HCC treatment method, consisting of multiple possible combinations of 44 informative parameters. Based on the current values of these parameters, expert knowledge is transformed into production rules identifying HCC treatment methods. A heuristic procedure treatment selection is developed based on production rule analysis in accordance with current parameter values, reproducing the reasoning patterns of participants in a multidisciplinary council during their consensus decision-making process regarding HCC treatment appointment. A software implementation of a decision-making model for HCC treatment selection, implemented in C# using the Visual Study 2019 platform, enabled the integration of an intelligent system with web technologies. The intelligent medical decision support system automates the unique experience of professionals and helps physicians in a multidisciplinary consultation make prompt and informed decisions online regarding the appointment of personalized therapy. The system was piloted with expert physicians in several iterations until complete match between the consensus decision of the multidisciplinary council and the decision made by the developed system in accordance with clinical recommendations was achieved

Background: This study is the first to investigate the association between colorectal cancer (CRC) risk and the hMLH1 −93G>A and hMSH2 1032G>A polymorphisms of mismatch repair (MMR) genes in the Azerbaijani population. Methods: Peripheral blood samples containing EDTA were collected from the study subjects (134 patients and 137 controls), and genomic DNA was extracted using the non-enzymatic salting-out method. Genotypes were determined by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP), and the results were visualized through agarose gel electrophoresis. Results: Overall, no statistically significant correlation was observed between CRC risk and the hMLH1 −93G>A polymorphism in the heterozygous GA (OR = 0.760; 95% CI = 0.374–1.542; p = 0.446), the mutant AA (OR = 1.474; 95% CI = 0.738–2.945; p = 0.270), or the A allele (OR = 1.400; 95% CI = 0.984–1.995; p = 0.062). However, in contrast to the dominant model, a statistically significant association was found between the recessive model and an increased CRC risk, with an odds ratio of 1.788 (95% CI = 1.102–2.900; p = 0.018). The hMLH1 −93G>A polymorphism was identified at a significantly higher frequency across the TNM stages, with the distribution showing statistical significance (p < 0.05). Additionally, no statistically significant association was observed between the hMSH2 1032G>A polymorphism and CRC risk. Conclusions: Although no overall association was observed for hMLH1 −93G>A, our findings suggest a potential link with increased colorectal cancer risk under the recessive model in the Azerbaijani population. Further studies are warranted to confirm this model-specific association and investigate the underlying biological mechanisms.

Background: This study is the first to investigate the association between colorectal cancer (CRC) risk and the hMLH1 -93G>A and hMSH2 1032G>A polymorphisms of mismatch repair (MMR) genes in the Azerbaijani population. Methods: Peripheral blood samples containing EDTA were collected from the study subjects (134 patients and 137 controls), and genomic DNA was extracted using the non-enzymatic salting-out method. Genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and the results were visualized through agarose gel electrophoresis. Results: Overall, no statistically significant correlation was observed between CRC risk and the hMLH1 -93G>A polymorphism in the heterozygous GA (OR=0.76; 95% CI=0.37–1.54; P=0.446), mutant AA (OR=1.47; 95% CI=0.74–2.95; P=0.270), or the A allele (OR=1.062; 95% CI=0.735–1.534; P=0.748). However, in contrast to the dominant model, a statistically significant association was found between the recessive model and a reduced CRC risk, with an odds ratio of 0.56 (95% CI=0.35–0.91; P=0.018). The hMLH1 -93G>A polymorphism was identified at a significantly higher frequency across the TNM stages, with the distribution showing statistical significance (P0.05). Additionally, no statistically significant association was observed between the hMSH2 1032G>A polymorphism and CRC risk. Conclusions: Our results indicate that the hMLH1 -93G>A polymorphism, particularly under the recessive model, may play a protective role against CRC risk in the Azerbajani population. Further studies are required to validate these results and investigate the underlying biological mechanisms.

Aim: The purpose of this study is to look into the prevalence of thyroid cancer in Azerbaijan's endemic and non-endemic regions, as well as the effect of unmanaged iodine prophylaxis on the development of thyroid cancer. Material and methods: The study includes 352 patients who were treated operatively for nodular goiter between 2015 and 2022. Patients were separated into two groups based on endemic (n=126) and non-endemic (n=226) regions, as well as two subgroups based on the number of nodules in the thyroid: single nodule (169) and multinodule (183). Thyroid cancer was discovered in 20 patients (15.9%) in the endemic zone (p=0259). Malignancy was found in 11 (8.7%) of single-nodular goiter (SNG) patients and 9 (7.1%) of multi-nodular goiter (MNG) patients (p=0,259): 19 (15.1%) had the classic variation of papillary cancer and 1 (0.8%) had the follicular variant of papillary cancer. Cancer was discovered in 47 cases (20.8%) (p=0.259) in non-endemic regions: malignancy was detected in 23 (10.2%) cases of MNG patients and in -24 (10.6%) of SNG patients. In non-endemic areas, 2 patients (0.7%) had follicular cancer, 36 (15.9%) had the classic type of papillary cancer, 7 (3.1%) had microcarcinoma, and 2 (0.9%) had medullary cancer (p=0,220). Results: Although there was a decrease in the frequency of incidence of goiter disease in general in endemic regions due to the prohibition of iodized table salt, an increase in the frequency of occurrence of MNG (56.4%) was noted. Thyroid malignancy have been identified in 15.9% of endemic nodular goiter patients and 20.8% of non-endemic nodular goiter patients. The significant percentage increase in papillary carcinoma in our region study was consistent with the literature. Conclusions: According to data collected in endemic areas, the use of unregulated iodine prophylaxis resulted in a decrease in the prevalence of follicular carcinoma while increasing the frequency of papillary carcinoma. The prevention of iodized table salt under the conditions of sanitary-epidemiological follow-up under the control according to the endemic characteristics of the regions can lead to a decrease in the risk of follicular cancer