MEDICO-BIOLOGICAL SCIENCES
ORIGINAL ARTICLES
THE SIGNIFICANCE OF M-CHOLINOREACTIVE SYSTEMS IN THE IMPLEMENTATION OF THE INFARCT-LIMITING EFFECT OF POSTCONDITIONING WITH L-LACTATE DURING MYOCARDIAL ISCHEMIA-REPERFUSION IN YOUNG AND OLD RATS
Chepelev S.N., Vismont F.I., Goubkin S.V., Yushkevich P.F., Chepeleva E.N.
Abstract: Objective. To determine the significance of M-cholinoreactive systems (M-CRS) in the implementation of the infarct-limiting effect of postconditioning with L-lactate (PostL) during myocardial ischemia-reperfusion in young and old rats. Methods. The study was carried out on 141 white male rats. The animals were divided into 8 groups: Controlyoung and Controlold - young/old rats, which underwent 30 minutes of myocardial ischemia followed by 120 minutes of reperfusion; Atropine + Controlyoung and Atropine + Controlold - young/old rats that were intravenous administered atropine at a dose of 2 mg/kg 15 min after myocardial ischemia/reperfusion; PostLyoung and PostLold - young/old rats that modulate PostL 25 min from the start of reperfusion; Atropine + PostLyoung and Atropine + PostLold - young/old rats that were administered atropine at a dose of 2 mg/kg 15 min after myocardial reperfusion and 10 min after this were subjected to PostL. After reperfusion, the heart was removed and the size of the necrosis zone was studied using computer planimetry. Results. The sizes of the necrosis zone in the left ventricular myocardium in animals in the study groups were as follows: Controlyoung was 45 ± 4 %, Controlold - 47 ± 5 %, Atropine + Controlyoung - 47 ± 5 %, Atropine + Controlold - 48 ± 7 %, PostLyoung - 33 ± 3 % ( p < 0,01), PostLold - 35 ± 4 % ( p < 0,01), Atropine + PostLyoung - 41 ± 4 %, Atropine + PostLold - 32 ± 4 % ( p < 0,01). Conclusion. Under conditions of action in animals of atropine (2 mg/kg), the infarction-limiting effect of PostL is preserved in old but not young rats. The data obtained give grounds to say that M-CRS activity is important in the mechanisms of implementation of the infarct-limiting effect of PostL in young, but not in old rats.
Keywords: infarction-limiting effect, ischemia-reperfusion injury, postconditioning with L-lactate, atropine, M-cholinergic systems, age
BEHAVIORAL CORRELATES OF ETHANOL WITHDRAWAL AFTER FORCED ADMINISTRATION IN RATS
Shabanov P.D., Likhtman Ya.B., Lebedev A.A.
Abstract: Objective. To study the behavioral reactions of rats during the period of ethanol administration in increasing doses and after discontinuation of ethanol administration. Methods. Behavioral methods for studying rats were used: self-stimulation of the lateral hypothalamus, open field, elevated plus maze, “resident-stranger”, Porsolt test. Ethanol was administered in increasing doses of 0.5-1-2-4 g/kg for 4 days with behavioral assessment after 24 hours and 72 hours after administration of the last dose of ethanol. Results. Forced administration of ethanol for 4 days in increasing doses (0.5-1.0-2.0-4.0 g/kg) and its subsequent withdrawal changes the behavior of animals. Ethanol moderately increases the activity of the brain's rewarding systems, especially at a dose of 2 g/kg. In the “open field”, signs of post-intoxication effects of ethanol were revealed, which were recorded 24-72 hours after its last administration. Ethanol withdrawal is accompanied by a decrease in motor behavior indicators (mainly after 24 hours) with increased indicators of grooming and emotionality (after 24 hours and 72 hours). In the elevated plus maze, ethanol withdrawal has a multidirectional effect on anxiety, slightly reducing it after 24 hours and sharply increasing 72 hours after the last administration of ethanol, which indicates the persistence of signs of post-intoxication syndrome. In the “resident-intruder” test, the withdrawal of ethanol disinhibits the aggression/defense system and reduces the sociability of animals, and these signs are recorded both 24 hours and 72 hours after the last administration of ethanol. Finally, in the Porsolt test, during the period of ethanol withdrawal, only after 24 hours, the time of immobilization moderately increases, which indicates an increase in the depressiveness of the animals. Conclusion. This allows us to qualify the method of forced administration of ethanol in increasing doses followed by its withdrawal as a convenient way to assess the behavioral elements of dependence on ethanol and other psychotropic substances.
Keywords: ethanol, gradual introduction, forced alcoholization, brain reinforcement, withdrawal syndrome, behavior, rats
SELECTED PHARMACOECONOMICAL STUDIES OF THE TREATMENT OF CHILDREN AND ADOLESCENTS WITH CARDIAC ARRHYTHMIAS AGAINST THE BACKGROUND OF COVID-19 AT THE INPATIENT AND OUTPATIENT STAGES OF TREATMENT
Sokolovskaya V.V., Krikova A.V., Litvinova A.A., Tswetnaya I.N.
Abstract: Objective. To conduct a separate pharmacoeconomical study of the treatment of cardiac arrhythmias in children and adolescents after a new coronavirus infection by COI analysis Methods. The analysis of medical records of sick children and adolescents who have undergone COVID-19 was carried out. (sinus arrhythmia (n=65), sinus bradycardia (n=20)). Pharmacoeconomical research by the method of COI analysis was carried out at the inpatient and outpatient stages of medical and pharmaceutical care. The study identified "patient models" taking into account age groups, variants of rhythm disturbance and actual clinical practice. Results. When studying the patient's model "Sinus arrhythmia", it was found that the direct medical costs for the cost of laboratory research methods on average amount to 1590.0 rubles, and for the cost of instrumental methods - 5400.0 rubles. When calculating the direct costs of drug therapy for patients of this category, it was found that the price range of medicines varies from 299.0 rubles to 633.0 rubles for pharmacy organizations in Smolensk. When calculating the cost of treatment courses of different duration, it was found that 10, 30 and 60 days of treatment on average costs the health care system or a family with a child with this pathology from 574.8 rubles, 1724.6 and up to 3449.2, respectively. At the stage of inpatient treatment (14 days), direct medical costs are: 804.7 rubles for drug therapy, an average of 1590.0 rubles are spent on laboratory research methods, and 5400.0 rubles for instrumental ones. When calculating the cost of laboratory analysis methods for a model Conclusions. The study found that the direct medical costs per patient - the patient model "Sinus arrhythmia" are: for 14 days - 7794.7, for a course of treatment for 10 days - 7564.8 rubles, for 30 days - 8714.6 rubles and 60 days of treatment - 10439.2 rubles; per patient - the patient model "Sinus bradycardia" They amount to: 28911.5 rubles for 14 days, 28624.8 rubles for a course of treatment for 30 days, 30058.4 rubles for 90 days and 30775.2 rubles for 120 days of treatment.
Keywords: new coronavirus infection, COVID-19, ECG, cardiovascular complications, pharmacoeconomics
REVIEWS
MODERN APPROACHES TO UNDERSTANDING THE MAIN EFFECTS AND MECHANISMS OF ACTION OF INJECTION-BASED CARBOXYTHERAPY
Kokareva I.N., Abbasov R.R., Gorbushina N.E., Khalepo O.V.
Abstract: Objective. Systematize research data on the main local and systemic mechanisms of action of injection-based carboxytherapy and its effects on various pathologies. Methods. Data analysis using domestic and foreign studies of the molecular, cellular and systemic mechanisms of action of carboxytherapy, its effect on the functional activity of organs and systems, and possibility of use in pathogenetic therapy for various pathologies. Results. CO2 affects the blood flow, causing arterial hyperemia, enhances the dissociation of oxyhemoglobin, causes excitation of central and peripheral chemoreceptors, and regulates the breathing process. An increase in CO2 concentration has a positive ino- and chronotropic effect on the myocardium, increases volumetric blood flow, increases the oxygen extraction ratio in tissues and enhances their metabolism. In the endothelium, CO2 administration increases the production of vasodilators and the vascular endothelial growth factor, which contributes to the activation of peripheral circulation and enhancement of oxygenation and lipolysis in tissues. Stimulation of reflexogenic zones during carboxytherapy contributes to the analgesic effect. Conclusions. Administration of CO2 via injection, which allows precise dosing of gas volume and has minimal complication risks, is a promising method of pathogenetic therapy for various pathologies, although it is necessary to develop treatment protocols for specific nosological forms, and the mechanisms of action and effects of carboxytherapy require further research.
Keywords: carboxytherapy, carbon dioxide, microcirculation, vascular endothelium, Bohr effect, hypercapnia
ON THE ROLE OF THE PATHOLOGY SERVICE IN THE DIAGNOSIS OF INFECTIOUS DISEASES
Dmitriev I.V., Ignatova N.B., Abrosimov S.Yu.
Abstract: Objective. To assess the role of the pathology service in the diagnosis of infectious diseases. Methodology. The conceptual, process, situational, logical and systematic analysis of full-text versions of literary sources related to the diagnosis of infectious diseases in the work of a clinical pathologist was used. Results. The data on the capabilities of the pathoanatomical service for the diagnosis of infectious diseases at the present stage of health care development are presented. The problems in determining the etiology of infections are analyzed and ways to solve them are proposed. Conclusions. The predominant use of only routine research methods in pathoanatomical practice does not allow us to identify the etiology of many pathological processes of inflammatory genesis. In addition to improving training methods and strengthening the material and technical base, it is desirable to create a three-level system for identifying infectious agents in the pathology service. The first level will be represented by the pathology department (laboratory); the second level - by the basic specialized institution of the subject of the Russian Federation; the third level - by the specialized pathology center subordinate to the Ministry of Health of the Russian Federation. After legislative registration, it will be necessary to improve the interaction of these structures, including using telemedicine methods. To accomplish these tasks, a target program approved at the state level for the diagnosis of infections in pathoanatomical practice will be very important.
Keywords: pathological anatomy, diagnosis, infectious diseases
PHARMACOLOGICAL NEUROPROTECTION IN ISCHEMIC BRAIN LESIONS (PART 2. POSSIBLE APPROACHES TO PHARMACOLOGICAL NEUROPROTECTION)
Novikov V.E., Pozhilova E.V.
Abstract: Objective. Evaluation of the effectiveness of pharmacological neuroprotection and the prospects for its clinical use in ischemic brain lesions. Methods. Collection, systematization and analysis of literature data and the results of our own research on the experimental and clinical study of pharmacological neuroprotection in ischemic brain lesions. Results. The second part of the work presents a detailed analysis of possible approaches to pharmacological neuroprotection, taking into account the main pathogenetic pathways of the ischemic cascade and the physiological mechanisms of neuroprotection. The results of scientific research on primary and secondary pharmacological neuroprotection are discussed. It is noted that it is possible to realize the main goals of pharmacological neuroprotection in two ways: by blocking the pathogenetic links of the ischemic cascade (primarily glutamate excitotoxicity and oxidative stress) and by inducing the processes of neuroplasticity and neurotrophy. At the same time, it is important to make a reasonable choice of drugs to influence the reactions of the ischemic cascade and the physiological mechanisms of adaptation. Promising possibilities of using various pharmacotherapeutic agents for primary and secondary neuroprotection are considered. Conclusion. There are different approaches to pharmacological neuroprotection in ischemic brain lesions. The rational choice of targets (pathogenetic and physiological) and drugs for primary and secondary pharmacological neuroprotection determine its effectiveness, as they consistently increase the resistance of brain cells to ischemia/hypoxia and stimulate reparative-regenerative processes in the central nervous system.
Keywords: pharmacological neuroprotection, glutamate excitotoxicity, oxidant stress, cerebral ischemia, pharmacological targets
PHARMACOLOGICAL CHARACTERISTICS AND POSSIBILITIES OF USING JANUS KINASE INHIBITORS IN THE CLINICAL PRACTICE OF A DOCTOR
Chernova D.L., Platonov I.A.
Abstract: Objective. Analysis of the pharmacokinetics and pharmacodynamics of janus kinase inhibitors and evaluation of the effectiveness of their use in clinical practice. Methods. A comprehensive analysis of published international and domestic studies was carried out in the direction of a new pharmacological group of JAK-STAT inhibitors. Results. A new class of drugs and their mechanisms of action have been studied. Clinical achievements and prospects for the use of JAK inhibitors in clinical practice are reviewed. Conclusion. The considered group of drugs (ruxolitinib, tofacitinib) has shown high effectiveness in the treatment of various diseases, such as myelofibrosis, rheumatoid arthritis, ulcerative colitis. In addition, survival rates and biochemical analyzes confirmed the rationality of using Janus kinase inhibitors in the treatment of many diseases.
Keywords: janus kinase inhibitors (JAK), tofacitinib, ruxolitinib, COVID-19, myelofibrosis
PHARMACOEPIDEMIOLOGY OF TREATMENT OF PATIENTS WITH CORONARY HEART DISEASE DEPENDING ON THYROID FUNCTION
Iskenderov B.G., Lokhina T.V., Mozhzhukhina I.N.
Abstract: Objective. Study and analyze current data on genetic nature atrial fibrillation (AF) and assess the importance of genetic risk in the diagnosis and determination of prognosis, as well as become familiar with the issues of genotype-based pharmacotherapy for familial AF. Methods. Collection, analysis, and systematization of data on the genetic nature of AF. Results. This review article presents current concepts about genetic predictors of AF, including genes involved in the regulation of cardiac ion channels, transcription factors, and secondary risk factors for AF. Modern therapeutic technologies are described in detail, the choice of treatment tactics and assessment of the effectiveness of interventional interventions and genotype-based antiarrhythmic pharmacotherapy. Conclusions. It has been shown that the familial form of AF is quite common in the general population, makes a serious contribution to mortality and thereby diverts enormous economic resources to solve medical and social problems associated with the provision of specialized medical care. In this context, verification of patients with familial AF will contribute to early diagnosis and prevention of cardiovascular complications associated with AF, as well as the introduction of effective pharmacotherapy and interventional procedures.
Keywords: atrial fibrillation, genetic risk, antiarrhythmic therapy, catheter ablation
CLINICAL MEDICINE
ORIGINAL ARTICLES
A 6-MINUTES WALK TEST MODIFICATION FOR PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Punin D.A., Zhemoedov M.V., Yudanova T.A., Punin A.A., Tsarev S.A.
Abstract: Objective. To develop a new indicator reflecting exercise tolerance and compensatory capabilities of a patient with COPD - desaturation area in the first minute of the recovery period to the walked distance ratio in a 6-minute walk test. Methods. A 6-minute walk test was performed in 31 COPD patients. The area of desaturation during a 6-minute walk period, as well as in the first minute of the recovery period were measured; the ratio of the above areas to the walked distance was calculated (DDR and D1DR, respectively). A correlation analysis was conducted between DDR, D1DR, spirometry indicators and the severity of COPD symptoms. Regression models of DDR and D1DR to FEV1 were built. Results. A very high correlation was observed between DDR and D1DR. The strength of the correlation between D1DR and pulmonary ventilation parameters was weak to moderate and was comparable to the strength of the correlation between DDR and the corresponding measures of pulmonary ventilation. The regression models built for pulmonary function indicators explained 33% of the variance in DDR and 30% of the variance in D1DR, which suggests the presence of factors other than pulmonary ventilation impairment that influence the decrease in patients’ exercise tolerance. Conclusions. The DDR and D1DR indicators reflect COPD patients’ exercise tolerance and can be used to assess their compensatory capabilities. The advantage of D1DR over DDR is a simpler method for measuring the indicator.
Keywords: Chronic Obstructive Pulmonary Disease, COPD, 6-minute walk test
CLINICAL CASE OF PULMONARY EMBOLISM AS A COMPLICATION OF COVID-19
Chudaeva O.V., Lagutina N.M., Chernousova E.M., Zhukova N.A.
Abstract: Objective. To analyze the medical history of a patient who underwent a new coronavirus infection COVID-19, against which a recurrent form of pulmonary embolism developed, as a result of which a thrombendarterectomy from the pulmonary artery system was performed first, and then a transluminal balloon angioplasty of the pulmonary artery. Methods. Analysis of medical records, medical history, complaints, laboratory and instrumental research methods. Results. A clinical case of a patient who suffered from a new coronavirus infection COVID-19, against which a recurrent form of pulmonary embolism developed, is presented. Subsequently, a thrombendarterectomy was performed from the pulmonary artery system, and then a transluminal balloon angioplasty of the pulmonary arterioles was performed by the National Medical Research Center for Cardiovascular Surgery (FSBI NMIC SSH) named after A.N. Bakulev. This patient suffered a new coronavirus infection at the end of December 2021. He complained of shortness of breath and elevated body temperature to the Yartsevskaya CRH, where he was hospitalized in KB No. 1 with a positive smear for Covid-19. During hospitalization, bilateral destructive pneumonia was detected. Due to the presence of weakly positive dynamics of the condition, as well as a negative smear on Covid-19, the patient was hospitalized in the thoracic department of the Smolensk Regional Medical Center in connection with bilateral destructive pneumonia. After a month of hospitalization, the patient noted a deterioration in his condition when he woke up in the morning and began to feel at rest a feeling of lack of air, pronounced shortness of breath and weakness. The results of the examination revealed CT signs of bilateral massive pulmonary embolism, pneumonia infarction with destruction cavities; ultrasound signs of thrombosis of the superficial femoral vein on the left. Taking into account the ultrasound result, implantation into the infrarenal position of the cava filter was performed. Based on the results of the examination and the course of the disease, surgical treatment for massive PE was recommended. The patient was hospitalized at the Bakulev Federal State Medical University, where the operation was performed: thrombendarterectomy from the pulmonary artery system, the postoperative period was complicated by heart and respiratory failure. Due to the development of recurrent pulmonary embolism. Transluminal balloon angioplasty of the pulmonary artery on the left was performed. Currently, the patient is in a satisfactory condition and continues to be monitored on an outpatient basis by his attending physician. Conclusion. The new coronavirus infection COVID-19 provoked the patient to develop a recurrent form of pulmonary embolism. Based on the results of laboratory and instrumental examination methods, as well as taking into account complaints and the clinical course of the disease, a thrombendarterectomy from the pulmonary artery system was performed. Due to the development of recurrent pulmonary embolism, transluminal balloon angioplasty was prescribed. After the operation, the patient's condition improved, and there were no complications of surgery.
Keywords: new coronavirus infection, pulmonary embolism, PE, thrombendarterectomy, transluminal balloon angioplasty
VAPE-ASSOCIATED LUNG DISEASE. CLINICAL CASE ANALYSIS
Punin A.A., Pikalova O.S., Orekhova A.O., Khutorova E.A.
Abstract: Objectives. To analyze a clinical case of vape associated lung injury in a 23-year-old girl to demonstrate clinical manifestations of the disease, diagnostic algorithm of examination and compliance of the obtained results with the diagnostic criteria of EVALI syndrome (e-cigarette, or vaping, product use associated lung injury or lung damage associated with the use of electronic cigarettes or vaping). Methods. Analysis of the clinical course of vape-associated lung injury according to the data of anamnesis, general clinical examination of the patient, results of laboratory, radiological and instrumental methods of investigation. Results. The demonstrated description presents a clinical case of lung lesions on the background of vape smoking in a 23-year-old girl. The diagnosis of EVALI syndrome was made on the basis of full compliance of clinical manifestations, paraclinical and radiologic findings with the diagnostic criteria for vape-associated lung disease proposed by the Center for Disease Control and Prevention, a federal agency of the U.S. Department of Health for use in general medical practice: use of e-cigarettes for 90 days; pulmonary shading on chest radiologic evaluation; exclusion of pulmonary infection, including by active anti-tobacco campaign has significantly influenced public attitudes towards tobacco smoking. Conclusion:This clinical case of vape-associated lung damage is a clear example of the negative impact of vaping on human health.
Keywords: vaper disease, EVALI syndrome, lung damage by vaping
PREVENTIVE MEASURES FOR THE CORRECTION OF GERIATRIC FACTORS IN OSTEOARTHRITIS OF LARGE JOINTS
Khisomov K.H., Ondar V.S., Akhpashev A.A.
Abstract: Objective. This article explores the use of preventive measures to correct geriatric risk factors in elderly patients suffering from osteoarthritis of the knee and hip joints. The aim is to provide an understanding of complex therapeutic and preventive approaches during endoprosthetics, thereby optimizing treatment results and meeting the specific needs of this category of patients. Methods. A comprehensive geriatric study was conducted to identify key characteristics and risk factors in elderly and senile patients with osteoarthritis. Among them: pain syndrome, limited joint mobility, joint edema, radiological signs of osteoarthritis, cognitive impairment, risk of malnutrition, depression syndrome, high levels of pain and decreased quality of life. Results. The obtained results emphasize the importance of a comprehensive geriatric assessment for understanding the mechanisms of osteoarthritis in elderly patients. Based on the identified risk factors, recommendations are formulated for the management of medical personnel in dealing with this category of patients. The purpose of these recommendations is to prevent negative consequences and improve treatment outcomes by taking into account the basic level of activity, cognitive impairment, malnutrition, pain management and quality of life. Conclusion. The study highlights the importance of a multimodal approach to the correction of geriatric risk factors in elderly and senile patients with osteoarthritis. By integrating comprehensive geriatric assessment and implementing preventive measures, healthcare professionals can individualize treatment strategies and improve patient outcomes. The results contribute to the development of individualized interventions and provide valuable insights to improve the care provided to this vulnerable category of patients.
Keywords: osteoarthritis, elderly, senile age, geriatric risk factors, preventive measures, comprehensive geriatric assessment, endoprosthetics, treatment results
PROBLEMS OF THE RELATIONSHIP OF SARCOPENIA, VISCERAL OBESITY AND OSTEOPENIA IN WOMEN OVER 40 YEARS OLD
Bazhenova D.S., Dekhnich S.N., Mikhalik D.S., Shilina A.A., Kutsevalova O.E.
Abstract: Objective. To study the prevalence of certain geriatric syndromes (sarcopenia, osteopenia), visceral obesity and their combination in females aged 40 to 74 years in outpatient practice. Methods. 111 women were examined on an outpatient basis, aged 40-59 years (n=43) - group 1, aged 60-74 years (n=68) - group 2 with various comorbid pathologies. Anthropometric data (height, weight, BMI) were studied; we used the F-A-C-S algorithm (EWGSOP 2) to diagnose sarcopenia, with determination of muscle strength (MS) on the TVES-DMER-120 dynamometer, muscle mass (MM), lean body mass, visceral fat level (VF) using bioimpedancemetry (Multiscan BC-Oxi analyzer, Russia). Bone mineral density (BMD) was assessed using ultrasonic densitometry of the calcaneus (FURUNO CM-200 light, Japan) with determination of ultrasound speed (SOS m/s) and T-criterion. Results. The incidence of sarcopenia and osteopenia in women was similar in middle (30.3% and 33.7%) and elderly (58.5% and 56.5%) age in the study sample. Visceral obesity in old age was 2 times more common (82.4%) than on average (41.9%). In middle age, a “risk group” was identified for an unfavorable body composition profile (BCM): a combination of reduced MM (< 30% of BCM) and increased BWL (>9%) - the “sarcopenic obesity” phenotype. In old age, the number of such patients increased, which requires personalized approaches to prevention and treatment. There was no linear relationship between osteopenia and reduced MM values when studying BMD indicators (T-score) in this sample, however, with a decrease in BMI, there was a tendency towards an increase in the incidence of osteopenia in both middle-aged and elderly women. Conclusion. The study of BCM using bioimpedansometry in patients over 40 years of age in an outpatient setting allows us to identify a “high-risk group” for the development of sarcopenic obesity with a decrease in MM and an increase in VF, which requires further in-depth examination and observation of specialists (endocrinologists, geriatricians).
Keywords: sarcopenia, visceral obesity, osteopenia, prevention
THE COURSE OF CHRONIC FORMS OF CORONARY HEART DISEASE IN ASYMPTOMATIC HYPERURICEMIA
Bazina I.B., Kozyrev O.A., Akulenok E.V., Sidorenko K.V., Khokhlova Yu.A., Zubkov S.K., Pavlova M.V.
Abstract: Objective. To analyze the course of chronic forms of coronary artery disease, its complications in patients with asymptomatic hyperuricemia and without hyperuricemia, evaluate the correction of uric acid levels in cardiac practice. Methods. The materials of medical histories of patients who were treated in the cardiology department of the OGBUZ "City Clinical Hospital N1" with chronic forms were analyzed of chronic forms of coronary artery disease. Results. 64 patients with chronic forms of coronary artery disease aged 34 to 84 years were examined. Patients with hyperuricemia (42 subjects) comprised Group 1; patients without hyperuricemia (22 people) - group 2. In group 1, cardiovascular complications (myocardial infarction, stroke, rhythm disturbances), type 2 diabetes mellitus, higher values of total cholesterol (p≤0.05), low-density lipoprotein cholesterol (p≤0.01), C-reactive protein (p≤0.001). The SCORE2 index in the 1st group was 15.1±6.7., In the 2nd group 12.5 ± 7.8. Patients with a very high cardiovascular risk in group 1 amounted to 54.8%, with a high risk - 23.7%; in group 2, 40.9% and 22.7%, respectively. Intracardiac hemodynamics in both groups did not differ significantly. The thickness of the intima-media complex of the common carotid artery prevailed in patients with hyperuricemia (p≤0.05). In Group 1, allopurinol was prescribed to 16.7% of patients. Patients with very high and high cardiovascular risk amounted to 78.5%, which indicates insufficient correction of uric acid levels in cardiac patients. Conclusion. Patients with hyperuricemia have a more severe course of cardiovascular diseases due to significant metabolic disorders, inflammatory reactions, remodeling of the heart and blood vessels, and a decrease in GFR. In cardiac patients, the correction of the MC level is not actively carried out with the achievement of its target levels below 300 μmol/L.
Keywords: hyperuricemia, cardiovascular diseases, allopurinol
A CLINICAL CASE OF SUCCESSFUL TREATMENT OF HYPERTENSION IN COMBINATION WITH TACHYCARDIA IN A POLYCLINIC
Yankovaya T.N., Kuleshov N.S., Derevyankina A.V.
Abstract: Objective. To provide a clinical case of treatment of a patient with arterial hypertension in combination with tachycardia. Methods. Outpatient follow-up, analysis of therapeutic and diagnostic tactics for the management of a patient with arterial hypertension in combination with tachycardia. The available literature on the effect of tachycardia and hypertension on the prognosis and risk of cardiovascular complications has been analyzed. Results. A clinical case of outpatient management of a patient with arterial hypertension and tachycardia is presented. The effect of antihypertensive therapy on clinical symptoms, blood pressure and pulse parameters is analyzed, and treatment results are described. Conclusion. The correct choice of antihypertensive drugs is an extremely important element of the therapy of patients with hypertension, occurring against the background of tachycardia. An adequate combination of antihypertensive drugs in such patients reduces the risk of mortality from cardiovascular complications. A differentiated approach to the selection of antihypertensive therapy is necessary for patients with arterial hypertension in combination with tachycardia, to improve the prognosis and reduce the risk of cardiovascular complications.
Keywords: arterial hypertension, tachycardia, hypotensive therapy
CLINICAL CASE OF DIAGNOSTICS AND TREATMENT OF A PATIENT WITH MARFAN SYNDROME
Chudaeva O.V., Samylova A.R., Vlasova D.V., Korcheva V.S., Airapetov K.V.
Abstract: Objective. To consider the clinical case of the course of the familial form of Marfan syndrome, modern diagnostic possibilities of the disease, prognosis with timely therapy. Methods. The article is devoted to the diagnosis and treatment of a patient N., 1983 year of birth with the family form of Marfan syndrome (Father’s abdominal aorta dilation, the father’s cousin shows signs of Marfan syndrome). Results. The diagnosis was first set at the age of four years. The patient showed lesions of the damage to the cardiovascular system (aortic enlargement, aortic failure, signs of pulmonary hypertension, failure of heart valves, paroxysmal bradycardia), lesions of the musculoskeletal system (flat foot, keeled chest wall deformation, scoliosis), damage to the nervous system (TIA, chronic cerebrovascular insufficiency). Conclusion. In connection with the progression of the disease had received surgery Bentall-de Bono, prosthetic repair of the ascending aorta with the addition of sauce on Karbol; The right foot surgery. Resection of aortic aneurysm with prosthetic and roximal parts descending thoracic aortic. These surgery allowed the patient has contributed to a positive dynamics.
Keywords: Marfan syndrome, aortic aneurysm, mitral valve prolapse, mechanical valve, hybrid explant
FEATURES OF THE INDICATORS OF ULTRASOUND DOPPLER EXAMINATION OF THE VESSELS OF THE BRAIN AND NECK IN CHILDREN RAISED IN SOCIAL INSTITUTIONS WHO HAVE SUFFERED CHRONIC INTRAUTERINE HYPOXIA IN THE ANTENATAL PERIOD
Udovenko A.A., Shestakova V.N., Sosin D.V., Evseev A.V., Glushchenko V.A., Indyukova E.D., Lyamec L.L.
Abstract: Objective. To identify the features of the main indicators during the ultrasound Doppler examination of the vessels of the brain and neck in children aged 7-11 years who are brought up in social institutions for minors who have suffered chronic hypoxia in the antenatal period of the tactical approach to providing assistance at this stage of development. Methods. The study involved 110 children of primary school age who were brought up in institutions of the social sphere for minors (n=110). The main group included 60 children experiencing chronic intrauterine hypoxia (n=60), the remaining 50 children, without chronic hypoxia in the antenatal period, made up the comparison group (n=50). The ultrasound examination was performed using a SIEMENS Acuson X-300 device. During the examination, standard accesses through the temporal and occipital windows were used. Ultrasound Dopplerography was performed in the supine and supine position, as well as examination of the vessels of the neck on the right and left: common carotid, internal carotid, external carotid and vertebral arteries. The following indicators were determined: linear blood flow rate (LSC, cm/s) and resistance index (RI). The average values were used to quantify the central trends of the analyzed samples. Results. In the main group of children, the values of peak systolic blood flow velocity in the anterior cerebral artery were 99.06±8.78 cm/s, the posterior cerebral artery was 84.31±8.07 cm/s, the vertebral artery was 76.75±6.11 cm/s and the main artery was 88.75±5.51 cm/s, which was significantly higher (p<0.05) than in the comparison group, where in these arteries the peak systolic velocity was determined in the intervals: 93.17±3.19 cm/s, 70.7±4.02 cm/s, 58.33±2.49 cm/s, 83.07±3.25 cm/s, respectively. When comparing the maximum final diastolic and time averaged blood flow rates, the interval values of which in children who have suffered chronic intrauterine hypoxia in the middle cerebral artery are 45.97±1.95 cm/s and 82.8±3.63 cm/s, the posterior cerebral artery is 40.95±2.5 cm/s and 62.63±5.12 cm/s, vertebral artery - 38.64±2.36 cm/s and 57.69±4.17 cm/s, the main artery - 41.17±2.6 cm/s and 64.96±3.68 cm/s, and in children who had no signs of chronic intrauterine hypoxia, in similar vessels: 57.38±4.57 cm/s and 91.52±6.94 cm/s, 32.84±2.03 cm/s and 51.77±2.97 cm/s, 29.01±2.09 cm/s and 43.67±2.06 cm/s, 38.3±1.83 cm/s and 60.69±2.34 cm/s, respectively, significantly higher (p<0.05) blood flow rates in the main group in the posterior cerebral, vertebral and main arteries were revealed, while significantly lower (p<0.05) in the middle cerebral artery, rather than in the comparison group. Significantly higher (p<0.05) values of resistance and pulse indices were observed in the main group in the middle and anterior cerebral arteries, and in the comparison group in the posterior cerebral and vertebral arteries, while no significant differences were found in the main artery (p≥0.05). Analysis of the results of ultrasound Doppler examination of the vessels of the neck showed that the children of the main group had significantly lower (p<0.05) values of linear blood flow velocity in the internal carotid artery, with values on the right 76.25±6.02 cm/s and on the left 74.37±5.49 cm/s versus the comparison group with intervals of 87.83±3.21 cm/s and 90.5±3.12 cm/s, simultaneously with significantly higher values (p<0.05) in the vertebral artery, where the values in the main group on the right and left are 67.13±2.34 cm/s and 67.25±3.3 cm/s, and in the comparison group 56.33±1.99 cm/s and 57.53±2.28 cm/s. Conclusion. The revealed features of cerebral hemodynamics during ultrasound Dopplerography of the vessels of the brain and neck in children aged 7-11 years who have suffered chronic intrauterine hypoxia indicate the possible nature of the occurrence of one or another variant of neuropsychiatric symptoms. The presence of chronic hypoxia in the prenatal period affects the processes of blood supply to certain areas of the brain, while these changes do not have a unidirectional character.
Keywords: teaching staff of the initial stage of education, chronic intrauterine fetal hypoxia, ultrasound Doppler examination of the vessels of the neck
EVALUATION OF THE MAIN INDICATORS OBTAINED USING DISPERSION MAPPING OF THE EDECTROCARDIOGRAM OF THE SCREENING SYSTEM "CARDIOVISOR" IN PUPILS OF SOCIAL INSTITUTIONS FOR MINORS OF PRIMARY SCHOOL AGE WHO HAVE SUFFERED CHRONIC FETAL HYPOXIA IN THE ANTENATAL PERIOD
Udovenko A.A., Shestakova V.N., Sosin D.V., Evseev A.V., Glushchenko V.A., Volkova E.A., Lyamec L.L.
Abstract: Objective. To identify the features of dispersion mapping of the electrocardiogram of the screening system "Cardiovisor" in children aged 7-11 years living in social institutions for minors who have suffered chronic intrauterine hypoxia in the antenatal period. Methods. The children of the orphanage aged 7-11 years (n=75) were taken for the study. Of these, 45 children who experienced chronic intrauterine hypoxia made up the main group (n=45), the comparison group included 30 children without a history of chronic intrauterine hypoxia (n=30). The assessment of the main indicators obtained using dispersion mapping of the electrocardiogram of the screening system "Cardiovisor" in primary school children from social institutions for minors who have suffered chronic fetal hypoxia was carried out. Such dispersion indices as "Myocardium", which shows the numerical expression of the area of the zone of violation of dispersion deviations, and "Rhythm", which characterizes the balanced effect of the nervous system on the cardiovascular system, were determined. Results. In the main observation group, the value of the Myocardium index was 10.75±2.31%, which is significantly higher (p<0.05) than in the comparison group, where the indicator was in the range of 7.76±2.27%. Since the "Myocardium" indicator, when interpreted, correlates with intervals that distinguish, depending on the total amount of variance deviations, borderline states from pathology, the proportion of children with values up to 15% in both groups was additionally calculated. In the comparison group, the number of such children was 73.3±16.1%, which is significantly higher (p<0.05) than in the main group at 42.2±14.7%. This indicates that in children who have experienced chronic intrauterine hypoxia, there are more pronounced dispersive deviations of the heart from the norm, which are caused by transient metabolic disorders of the myocardium. The index index "Rhythm" in both groups was recorded up to 50% and when comparing the average values, no significant differences were found (p≥0.05). This indicates that children who have experienced chronic intrauterine hypoxia are more susceptible to external influences, in particular stress factors, since the Rhythm index has a high dependence on the state of the nervous system. The presence of moderate tachycardia did not exceed the threshold of 30% in both groups: in the main group it was 26.7±13.2%, and in the comparison group it was 6.7±4.6% less. There were no significant differences in this trait (p≥0.05), as well as obvious signs of cardiac arrhythmia among children of both groups. In addition, the average heart rate values in the children of the main group and the comparison group were approximately at the same level - 79 beats/min. Conclusion. The features of the functional state of the myocardium revealed by us in primary school-age pupils from social institutions who have suffered chronic intrauterine hypoxia indicate that such children have more pronounced borderline changes in metabolic processes in the myocardium. This characteristic is a certain risk factor in the formation of functional pathology on the part of the heart, especially against the background of intensive growth of the body during this age period. At the same time, the influence of the nervous system on heart rate variability is noticeable, when children with a history of chronic intrauterine hypoxia have a more pronounced stress response, as a result of which there is some tension in the autonomic mechanisms, which largely causes functional changes. Therefore, the inclusion of such screening diagnostic methods as dispersion mapping of an electrocardiogram using the Cardiovisor system will help to diagnose disorders in a timely manner and timely carry out corrective measures for such children, among whom the frequency of perinatal pathology is quite high.
Keywords: children of the initial stage of education, indicators of the screening system "Cardiovisor", chronic intrauterine hypoxia, children of primary school age
A CASE OF NEUROFIBROMATOSIS IN THE PRACTICE OF A PEDIATRIC
Inozemtsova O.A., Gorshkova E.P., Antonova A.A., Kashirskaya E.I., Grishanova V.P., Yamanova G.A.
Abstract: Objective. Using a clinical example, show the features of the course and diagnosis of a case of neurofibromatosis type I in a child. Methods. The work used clinical and analytical research methods. The article presents a clinical case of a child who is a pupil of the state government institution of the Astrakhan region "Specialized Children's Home "Kapelka" in Astrakhan, with a diagnosis of Q85.0 "neurofibromatosis type I". An analysis of the materials of the medical record of the pupil of the “Kapelka” orphanage, the results of clinical, laboratory, and instrumental examination methods was carried out. Results. Using a clinical example, a diagnostic algorithm for diagnosing neurofibromatosis type 1 was analyzed. In this case, the diagnosis was complicated by the antisocial nature of the family and the lack of monitoring of the child at the place of residence. The importance of physician vigilance regarding a rare orphan disease and timely diagnosis is noted. Conclusion. A competent approach to work and the pediatrician’s awareness of the diagnostic criteria of the disease made it possible to diagnose phakomatosis at an early age, which in turn will definitely contribute to improving the child’s quality of life and the timeliness of specialized medical care for a rare orphan disease.
Keywords: clinical case, child, neurofibromatosis type I, café au lait spots
COMPARATIVE ANALYSIS OF CLINICAL MANIFESTATIONS, LABORATORY DIAGNOSTICS AND OUTCOMES OF INVASIVE FORMS OF MENINGOCOCCAL INFECTION IN CHILDREN OF THE SMOLENSK REGION AND VARIOUS REGIONS OF THE RUSSIAN FEDERATION (2012-2021)
Litvinova A.A., Sokolovskaya V.V.
Abstract: Objective. To study the clinical, epidemiological and laboratory features of invasive forms of meningococcal infection in children of the Smolensk region according to archival case histories for the period from 2012 to 2022, to conduct a comparative analysis of clinical manifestations, laboratory diagnostics and outcomes of GFMI in children in various regions of the Russian Federation and the Smolensk region. Methods. The analysis of 1327 cases of GFMI (purulent meningitis, meningococcemia, mixed form) for the period 2012-2021 was carried out. in children aged 1 month to 18 years, including 42 archival medical records of the Smolensk region. The main epidemiological, clinical and laboratory data have been studied. Results. According to the data obtained, only 28.6% of children were hospitalized within 12 hours of the onset of the disease, and 70.4% of the child - a day later. At the same time, the terms of hospitalization of children with GFMI significantly differed in different FOS. In 38.7% of cases, children of the Smolensk region were hospitalized with a directional diagnosis that differs from the diagnosis of "neuroinfection": 30.9% - ARVI, 2.3% - OCI, 7.1% - another directional diagnosis. The main clinical manifestations of GFMI have been identified. According to the data obtained in the Russian Federation, 70.8% had leukocytosis upon admission; Leukopenia was noted in 4.4% of cases, while normocytosis was typical for the rest of the patients. Significant differences in the quality of laboratory diagnostics between individual areas were revealed. On average, laboratory verification of the pathogen was noted in 76.5% (n=1015), while the Nm serogroup was established only in half of the cases. In the Smolensk region, almost 50% of the diagnosis was established exclusively clinically. Conclusions. The widespread spread of meningococcal infection among children in Smolensk was noted according to data for 2012-2022 with a predominance of invasive forms (80%), the predominance of mixed forms (MT+MK) in children was revealed. The low level of laboratory diagnostics of MI in the Smolensk region dictates the need to introduce molecular diagnostic examination methods into practice in order to verify pathogens and serogroups.
Keywords: meningococcal infection, children, laboratory diagnostics, vaccination
CONSTITUTIONAL APPROACH TO OUTPATIENT SUPPORT FOR PRESCHOOL CHILDREN WITH CHRONIC ADENOIDITIS
Sultanov I.S., Boboshko I.E., Zhdanova L.A., Boboshko I.V.
Abstract: Objective. To substantiate a program for supporting children aged 4-7 years of different types of psychoconstitution with chronic adenoiditis based on the identified differences in their health indicators and the characteristics of the clinical course of chronic inflammation of the nasopharyngeal tonsil. Methods. The study was carried out on the basis of the children's otorhinolaryngology department of the regional children's hospital in the city of Vladimir. A comprehensive assessment of the health of children with chronic adenoiditis was carried out, divided according to the scale of the direction of mental activity into types of introverts and extroverts. Results. The debut of chronic adenoiditis in introverts was at the age of 3-4 years, the main complaint was snoring with obstructive sleep apnea syndrome, the duration of the disease was about one and a half years, its course was complicated by frequent acute purulent otitis media, the prevalence of vagotonia and the formation of disorders of the dental system. In extroverts, chronic adenoiditis debuted at the age of 4-5 years, with a disease duration of about six months, its main manifestations were postnasal drip with night cough, signs of excessive sympathicotonia, early formation of exudative otitis media, hearing loss and the development of conductive hearing loss. Introverts were characterized by a predominance of microsomia and minimal indicators of the width and depth of the cavities of the skull and chest with maximum length; among the variants of physical development disorders - body mass deficiency. They were characterized by reduced social activity and high rates of fine motor skills and anxiety. In extroverts, the macrosomatic type with excess body weight predominated, had a high level of impulsiveness and aggressiveness, and good gross motor skills. Conclusion. The identified features of health and development indicators, the course of chronic adenoiditis in children 4-7 years of age of different types of psychoconstitution require individualization of their medical and social support, which should be the basis of a dispensary observation plan.
Keywords: chronic adenoiditis, psychoconstitution, extroverted type, introverted type, recurrent respiratory infection
FREQUENCY OF DETECTION OF MARKERS OF IMPAIRED LIVER FUNCTION AND THE FORMATION OF NON-ALCOHOLIC FATTY LIVER DISEASE IN CHILDREN AND ADOLESCENTS WITH METABOLIC DISORDERS
Demyanenko A.N., Ignatieva A.A., Demyanova E.A., Novikova Yu.S., Kirsanova A.A., Kurguzova E.A.
Abstract: Objective. To evaluate the frequency of detection of liver dysfunction and markers of the formation of non-alcoholic fatty liver disease in children and adolescents with metabolic disorders. Methods. The study included 97 children with metabolic disorders aged 10-17 years. The patients were divided into 3 groups: group 1 - children with type 1 diabetes mellitus and normal body weight (n=45), group 2 - children with type 1 diabetes mellitus who are obese (n=20), group 3 - children without diabetes mellitus who are obese (n=32). The study of the functional state of the liver included the determination of blood serum indicators of lipid metabolism, activity of liver enzymes. Liver ultrasound was performed to visualize changes in the hepatobiliary tract. Statistical processing of the results was carried out using the Statistica 7.0 program. Results. The patients in the study groups were comparable in age and gender. Patients of the 1st and 2nd groups were comparable in duration of diabetes, children of the 2nd group tended to have worse indicators of glycemic control. Among the patients of the 2nd group, 15 (75%) had simple obesity of the 1st degree, the 2nd - 5 (25%), and among the patients of the 3rd group - 8 (25%), 24 (75%). Hypercholesterolemia and dyslipidemia were more often diagnosed (p=0.072) in patients with diabetes mellitus who were obese (45% and 30%), both in comparison with patients with diabetes mellitus and normal weight (18% and 9%), and with simple obesity (28% and 13%). An increase in ALT and the ALT/AST ratio ≥ 1 was more common (p<0.05) among patients of group 3 (22% and 47%) compared with patients of group 1 (2% and 11%) and group 2 (10% and 25%). An increase in the size of the liver, a change inits structure during ultrasound in patients with diabetes mellitus and normal body weight was observed in 4%, with simple obesity in 19%, with diabetes mellitus with obesity - 20% of patients, and the absence of changes. Conclusion. Early markers of the formation of liver dysfunction are diagnosed in a quarter of patients with type 1 diabetes mellitus who are obese, which is twice as often as in children with diabetes mellitus and normal body weight, but half as often as in children with simple obesity. Patients with diabetes mellitus and normal body weight are more likely to have no changes in the liver during ultrasound compared with patients with diabetes mellitus who are obese, and with children without diabetes with simple obesity.
Keywords: type 1 diabetes mellitus, obesity, liver, children, non-alcoholic fatty liver disease
THE CLINICAL CASE OF A 6-YEAR-OLD GIRL WITH ARBALEDA-THAM SYNDROME
Filatova E.A., Razuvaeva Y.U.Y.U., Ledneva V.S., Ulyanova L.V.
Abstract: Objective. To study the etiology, pathogenesis, clinical symptoms, diagnosis and treatment of a rare genetic syndrome - Arbaleda-Tham syndrome. Methods. The authors present a clinical case of a 6-year-old child with Arbaleda-Tham syndrome. The analysis of the outpatient (f.112/y) and inpatient patient records, the results of clinical and anamnestic, laboratory and instrumental examination methods was carried out. Foreign literature sources (UpToDate, PubMed, ResearchGate databases) were analyzed, a comparative analysis of clinical and laboratory data, features of detection and diagnosis in previously described clinical cases of this rare pathology with the results obtained during the presented observation was carried out. Results. Arbaleda-Tham syndrome is a rare genetic disease caused by a mutation of the KAT6A gene. Common symptoms include varying degrees of mental retardation, delayed speech development, hypotension, pathology of the cardiovascular system, eyes and gastrointestinal tract. In most cases, variations in the KAT6A gene occur de novo. The article describes a clinical case of a rare genetic disease with a lesion of the KAT6A gene and clinical neurological manifestations. Conclusion. There are about 90 patients with Arbaleda-Tham syndrome all over the world. New diagnostic measures are being developed for better and earlier diagnosis of pathology, and, accordingly, early initiation of treatment.
Keywords: orphan diseases, children, KAT6A syndrome, Arbaleda-Tham syndrome
THE NATURE AND FREQUENCY OF JOINT DAMAGE IN CHILDREN WITH VARIOUS FORMS OF LIMITED SCLERODERMA
Osminina M.K., Podchernyaeva N.S., Alexakova N.V., Afonina E.Yu., Nicolaeva M.N., Ziskina N.K.
Abstract: Objective. To assess the nature and frequency of joint damage in children with limited scleroderma Methods included a physical examination of children, ultrasound, X-ray and magnetic resonance examination of damaged joints, the profile of autoantibodies and markers of fibrosis in blood serum was determined Results. Joint damage was diagnosed in 65.7% of children, mainly in severe forms of the disease with limb damage. Arthralgias were noted in 52% of patients, limited joint movements were detected in 60% of patients, more often due to compaction of periarticular tissues. Ultrasound revealed synovitis and tenosynovitis in 45% of children with joint damage, effusion in the joint in 16% of patients. MRI of the joints in 45 children revealed dystrophic changes in the form of thinning cartilage, in 15 narrowing of the articular gap.In patients with joint damage, antinuclear factor, rheumatoid factor, antibodies to collagen, high levels of fibronectin, hyaluronic acid and cryoglobulins were significantly more often detected. Conclusion. Children with limited scleroderma have frequent joint damage, which is accompanied by immunological activity of the disease and is confirmed by instrumental diagnostic methods.
Keywords: limited scleroderma, children, joint damage, autoantibodies, instrumental visualization
FAMILY SETUP AND REPRODUCTIVE PLANS OF INDIAN MEDICAL STUDENTS
Choudhary N.A.S., Pokusaeva V.N., Mitsyuk N.A.
Abstract: Objective. Family Planning and Reproductive Health are core issue in context of large and diverse population of India's large and diverse population. This research is aimed at studying family structure and reproductive plans among unmarried (eligible) medical students from India, their ideas about premarital sex, contraceptive use. Methods. Using a specially designed questionnaire, an online survey was conducted of Indian students (n=241) of a medical university from India who are studying in Russia, India and other countries. The scenario of possible decisions regarding unplanned pregnancy in terms of the influence of family, cultural and social factors on it is analyzed. Particular emphasis in the study is placed on the issues of sex education in the families of respondents and the possible influence of the parental family on the reproductive plans of young people. Results. Analysis shows results, which correlate with world trends: the model of a family with 1-2 children, delayed reproductive plans, the predominance of material needs over family values, tolerant attitude towards premarital sex and a high willingness to terminate an unwanted pregnancy. Conclusion. The findings highlight the need for holistic approaches aimed at improving the health literacy of young people in matters of reproductive behaviour, timely familiarization with effective reversible contraception.
Keywords: reproductive plans, artificial abortion, contraception, sex education
A CLINICAL CASE OF ISOLATION OF A POLYRESISTANT STRAIN OF ROAULTELLA TERRIGENA IN A UROLOGICAL PATIENT
Kuleshov A.A., Danilov A.I.
Abstract: Objective. To present a clinical case of isolation of a polyresistant strain of the pathogen in a patient with a complicated urinary tract infection. Methods. Based on a retrospective analysis, the anamnestic, clinical and microbiological data of a patient who was on inpatient treatment are summarized and presented. Results. The problem of treating urinary tract infections is especially relevant in the context of growing antibiotic resistance. The most acute issue is among patients with complicated urinary tract infections who undergo multiple courses of often irrational antimicrobial therapy, repeated hospital admissions and invasive urological interventions, which contributes to the selection of resistant strains, as well as their horizontal transmission. Conclusions. Currently, working with polyresistant pathogens of urinary tract infections has become routine, and it is increasingly necessary to deal with extreme and pan-resistant strains. At the same time, the centralization and isolation of the treatment of these patients in a particular region for a limited number of urological and nephrological hospitals allows for the existence of local features of etiology, pharmacoepidemiology and antibiotic resistance, which significantly deviate from the data of multicenter studies.
Keywords: complicated urinary tract infections, Roaultella terrigena, antibiotic resistance, surgical intervention
ANALYSIS OF THE PRESCRIPTIONS OF METAL LIGATURE BRACKET FROM FIRM AZDENT
Boikova E.I., Gulyaev I.E.
Abstract: Objective. Experimentally measure the numerical values of the torque and angle of Azdent brackets. Compare and identify the differences between Roth and MBT prescription brackets from this company. Methods. Experimentally, using an electronic goniometer, the torque and angle of brackets of Roth and MBT prescriptions were measured. The angles were projected on millimeter paper by means of a directional light source. The obtained values were compared with the standard values. Results. Numerical values of the torque and angle for each bracket are obtained. A table has been compiled based on the results of the study to facilitate the comparison of brackets of various prescriptions. For Roth registration: braces for the upper canine have a torc of -2.05°±0.76°, different from the 0° specified in the standard specification. For the MBT prescription: braces for the lower canine have a torc of +0.05°±0.82°, different from the one specified in the standard characteristic of the torc parameters -6°; braces for the lower first and second premolars have an angulation of +2.10°±0.83° and +1.95°±0.79°, respectively, different from the angulation specified in the standard characteristic of the parameters at 0°. The value of the torc for the upper canine in the MBT prescription of the studied braces company is -0.10 ° ± 0.78°, has a significant difference from the norm variant of -6 degrees, which plays a role in the future position of the canines of the upper jaw in the dental arch and should be taken into account by orthodontists when choosing equipment and planning orthodontic treatment. The data are analyzed and recommendations for practical application are given. Conclusion. During the study, it was found out that Azdent's Roth and MBT prescription brackets have similar values of torque and angle to brackets from other manufacturers, with the exception of the lower and upper canines, the first and second premolars of the lower jaw. Thus, orthodontists can use brackets from this company along with brackets from other manufacturers, but they must make a treatment plan in accordance with these features.
Keywords: брекеты, брекет-система, пропись брекетов, торк, ангуляция
REVIEWS
SPECIAL CASES OF ATRIAL FIBRILLATION: FEATURES OF COMORBIDITY
Skotnikov A.S., Lazareva V.V., Gribova Yu.A., Ilyushina I.V.
Abstract: Objective. To determine the importance of an integrated approach to the diagnosis and therapy of a non-valvular form of atrial fibrillation developing against the background of a variety of combined pathology. Methods. Collection, systematization and analysis of literature data on the clinical study of the mechanisms of development of atrial fibrillation against the background of a number of comorbid conditions, as well as a review of antiarrhythmic drugs, taking into account their characteristics and limitations for use in conditions of comorbidity. Results. The article presents an analysis of the results of scientific research on the mechanisms of atrial fibrillation in patients with chronic obstructive pulmonary disease, obstructive sleep apnea syndrome, hyperthyroidism, chronic alcohol intoxication or obesity, as well as the main pathogenetic pathways of arrhythmogenesis in these conditions. It was revealed that the key factors in the development of atrial fibrillation are an imbalance in the work of neurohumoral systems (sympathetic and parasympathetic, natriuretic peptide, renin-angiotensin-aldosterone, kinin-kallekrein), persistent aseptic inflammation, oxidative stress, hemodynamic and electrolyte disorders, hypoxia, intoxication and heart remodeling. Conclusion. Management of comorbid patients with atrial fibrillation should be based on strategy of main risks minimization (prevention of cardioembolic stroke, venous thromboembolic complications, coronary events, decompensation of chronic heart failure, acute renal damage, worsening cognitive impairment, adverse events of anticoagulant and antiarrhythmic therapy of atrial fibrillation).
Keywords: atrial fibrillation, comorbidity, antithrombotic therapy, antiarrhythmic therapy
CLINICAL AND DIAGNOSTIC FEATURES OF METABOLIC SYNDROME IN CHILDREN WITH IODINE DEFICIENCY CONDITIONS
Sayfiddinzoda Zainabbibi Kh.
Abstract: Objective. To analyze modern scientific information about the pathological effect of microelement deficiency on the development of the child’s body, including iodine, in children’s nutrition. Methods. The review includes studies by foreign and domestic scientists related to this topic. Results. It has been established that without careful monitoring of the content of microelements in the diet of children, especially in mountainous areas, a number of pathological conditions of the cardiovascular and central nervous systems develop. Against this background, there is an increase in the incidence of obesity in children, in particular metabolic syndrome. This problem increasingly concerns the population of the Republic of Tajikistan. Some traditional behavioral factors play a major role in the development of obesity in children, in particular the predominance of consumption of carbohydrates and fats over proteins. Conclusions. In general, we can say that the clinical and diagnostic features of determining metabolic syndrome in children with iodine deficiency conditions remain not fully developed to date. It is necessary to conduct additional clinical studies to improve the diagnostic algorithm for this category of individuals. All this determines the relevance of new research aimed at solving the problems mentioned in the work.
Keywords: metabolic syndrome, iodine deficiency conditions, obesity, goiter
PHARMACEUTICAL SCIENCES
ORIGINAL ARTICLES
STABILITY STUDY OF TRANSDERMAL GEL WITH CHOLINE ALFOSCERATE
Tyunina E.D., Losenkova S.O.
Abstract: Objective. Study of the stability of model formulations of transdermal hydrogel with choline alfoscerate by long-term stability tests during storage under natural conditions for 12 months in aluminum tubes with internal lacquer coating from various manufacturers, as well as by the met. Methods. The authors developed the formulations of transdermal gel with choline nootropic alfoscerate and studied their stability by two methods. To study stability by long-term testing, gels of the two compositions were stored in a laboratory refrigerator in aluminum tubes at a temperature of 8-15°C and humidity of 55-65%, as well as in a dark place at room temperature of 20-25°C and humidity of 55-65%. Monitoring of indicators ("Description, Authenticity, Quantity, Single Impurity, Sum of Impurities, and Hydrogen pH") was carried out at certain intervals: immediately after the preparation of the gel (before packaging in tubes), as well as after 3, 6, 9 and 12 months of their storage. To study stability by the method of accelerated tests, gels in aluminum tubes were put into a thermostat at a temperature of 38-42°C and humidity of 70-80% for 9 months (which corresponds to 36 months of storage in terms of natural storage according to the method [1]). Results. When studying the stability of gels by the indicators "Description", "Quantitative determination", "Single impurity", "Sum of impurities", "pH", during all observation periods, insignificant changes in the quality of hydrogel No. 1 were recorded during the study by long-term tests during its storage at a temperature of 20 to 25°C, as well as from 8 to 15°C. Based on the results of accelerated stability tests, it was determined that the gel with choline alfoscerate of composition N1 could potentially have a shelf life of 24 months in a tube produced by Linhardt-Altai LLC. During the study of gel composition No. 2 by the method of long-term tests during 12 months of storage, it was determined that it complied with the standardized indicators when stored in tube No. 2 at a temperature of 8-15°C. Conclusion. According to the results of the studies, the stability results without significant changes in the quality of the drug were shown by a transdermal gel with choline alfoscerate of composition No. 1 (composition: choline alfoscerate, Ultrez10 carbomer, methyl hydroxybenzoate, 1M sodium hydroxide solution, purified water), which was stored at various temperatures in a tube manufactured by Linhardt-Altai LLC in natural conditions for 12 months during all periods of observation. It is promising to continue the study of the stability of gels by means of long-term tests for 24 months.
Keywords: hydrogel, choline alfoscerate, long-term stability tests, accelerated tests
STUDY OF PATTERNS OF ACCUMULATION OF NATURAL AND MAN-MADE RADIONUCLIDES BY SYNANTHROPIC FLORA OF VORONEZH REGION ON EXAMPLE OF COMMON YARROW GRASS
Dyakova N.A.
Abstract: Objective. The purpose of the study is to study the patterns of accumulation of radioisotopes of natural and man-made origin in plant objects on the example of common yarrow grass (Achillea millefolium L.), harvested in the Voronezh region. Methods. Analysis of soil and grass samples of five-lobed motherwort was carried out on the gamma-beta-alpha-spectrometer-radiometer of the RADEK MKGB-01 with determination of the specific activity of basic (long-lived) artificial radionuclides (strontium-90, cesium-137) and natural radionuclides (potassium-40, thorium-232, radium-226), which are often found in nature. Results. All studied samples of plant raw materials prepared in natural and artificial phytocenoses of the Voronezh region meet the existing radiation safety requirements (first group). Correlation analysis of the specific activity of natural and man-made radionuclides in the soil and grass of the common yarrow showed the presence of a close relationship between these numerical indicators, which confirmed their predominant transposed pollution. With an increase in the specific activity of strontium-90, cesium-137, thorium-232, potassium-40, radium-226 in the soil, their specific activity in medicinal plant raw materials increased. For common yarrow grass growing in the Voronezh region, intensive accumulation from the upper layers of cesium-137 and potassium-40 soils was noted. Conclusion. For the accumulation coefficients strontium-90, thorium-232, potassium-40, radium-226 in the grass of the common yarrow, there are trends to decrease with an increase in their specific activity in the soil, which indicates the presence of physiological mechanisms for regulating their supply to the plant. The accumulation coefficients of cesium-137, on the contrary, increased somewhat, which indicates the ability of plant raw materials to accumulate this radionuclide. For the first time, the patterns and mathematical dependencies of the accumulation of technogenic and natural radionuclides in the grass of the common yarrow revealed as a result of the study make it possible to predict the peculiarities of contamination of plant raw materials with radioisotopes.
Keywords: Achillea millefolium L, Voronezh region, strontium-90, cesium-137, thorium-232, potassium-40, radium-226
QUANTITATIVE DETERMINATION OF THE AMOUNT OF PHENYLPROPANOIDS IN THE STEVIA SETTING BY SPECTROPHOTOMETRY
Kurdyukov E.E., Pravdivtseva O.E., Frindak K.A., Neklyudova V.A., Pleshakova D.A.
Abstract: Objective. To determine the quantitative content of the amount of phenylpropanoids in stevia tincture. Methods. The objects of the study were samples of tinctures from stevia leaves on alcohols of various concentrations - 40%, 70%, 96%. Quantitative determination of the amount of phenylpropanoids was evaluated by direct spectrophotometry in terms of chlorogenic acid. Samples of tinctures based on stevia leaves were obtained by modified maceration, percolation maceration and remaceration. The resulting tinctures are a transparent or opalescent brown-green liquid, the smell is specific, the taste is sweet Results. A study of the amount of phenylpropanoids in stevia tincture was conducted. The presence of phenylpropanoids was confirmed by direct spectrophotometry in a tincture of stevia leaves, the analytical maxima of the studied compounds were determined - 290 and 330 nm. The optimal extractant was determined - 70% alcohol, the optimal method for obtaining tincture was chosen. It was revealed that the content of phenylpropanoids in stevia tinctures varies in the range from 1.71 to 2.95%. Conclusion. Thus, studies have been conducted on the production and standardization of stevia tincture. As a method for quantifying the amount of phenylpropanoids of stevia tincture, we have proposed a method of direct spectrophotometry with the determination of the amount of phenylpropanoids in terms of chlorogenic acid, at an analytical wavelength of 330 nm.
Keywords: Stevia rebaudiana Bertoni, leaves stevia, phenylpropanoids, spectrophotometry, chlorogenic acid, tincture
ESTABLISHMENT OF MORPHOLOGICAL AND ANATOMICAL FEATURES OF THE HERB ASTRAGALUS DANICUS RETZ
Pozdnyakova T.A.
Abstract: Objective. To establish morphological, anatomical and microdiagnostic characteristics of the herb Astragalus danicus Retz. in accordance with modern requirements of regulatory documentation. Methods. The object of the study was the herb Astragalus danicus, harvested in the Kursk region in 2023 during the period of mass flowering of the plant. Macroscopic analysis was carried out in accordance with article GF XV «Herbs». Microscopic analysis was carried out in accordance with the General Pharmacopoeia Monograph of the State Pharmacopoeia XV «Technique for microscopic and microchemical examination of medicinal plant raw materials and medicinal herbal preparations» from whole leaves, pieces of leaf blade with edge and vein, pieces of leaf from the base and apex, pieces of petiole; calyx and its pieces, corolla, pieces of flower arrow and stem. To obtain microphotographs, a laboratory microscope «Biolam S-11» was used. Microphotographs were taken using a Nicon D 3100 digital camera. Photos were edited in PhotoScape v 3.5. Results. Whole raw material herb Astragalus danicus consists of non-lignified leafy stems about 15-20 cm long with flowers. All parts of the plant are covered with whitish or black hairs. The stems are ribbed, 3-4 mm thick, hollow. The leaves are imparipinnately compound with long petioles, 4-10 sm long, up to 3-5 sm wide, with 13-16 pairs of leaflets and triangular-lanceolate or semi-ovate stipules. Flowers of 10-20 are collected in dense capitate racemes on a long peduncle (up to 15-20 sm). The color of the stems is brownish-gray, the leaves are grayish-green, the flowers are purple-violet. The smell is weak and peculiar. The taste is bitter and astringent. The most characteristic microdiagnostic signs of Astragalus danicus are pubescence of the stem and leaf blade with long thick-walled hairs with a smooth or warty cuticle, consisting of long terminal and short basal cells with a rosette around the base, as well as pubescence of the calyx with numerous single-celled hairs with brown contents. Conclusions. Macro- and microscopic signs of the herb Astragalus danicus have been established, allowing for the diagnosis of «Astragalus danicus herb» raw materials.
Keywords: Astragalus danicus Retz, macro- and microscopic analysis, diagnostic signs
MINERAL COMPOSITION OF MEDICINAL PLANTS USED IN UROLOGY
Labkovskay M.V., Shmygareva A.A., Kurkin V.A.
Abstract: Objective. Compare the content of iron, manganese, copper, zinc, selenium, chromium and cobalt in the raw materials of membranous astragalus, woolly-flowered astragalus, pepper mountaineer, bird mountaineer, buckwheat, horsetail, madder dye and in the thick extracts obtained from them. Methods. The studies were carried out on an atomic absorption spectrometer "Kvant-2A", a mercury-hydride generator "GRG-111", laboratory scales VK-600, using a muffle furnace SNOL 8,2/1100, a water bath LOIP LB-161 (TB-6/W), RSO selena. The methods used are regulated by the following normative documentation GOST 30692-2000; GOST 32343-2013; GOST 31651-2012. Results. In the analyzed samples of raw materials of membranous astragalus, woolly-flowered astragalus, pepper mountaineer, bird mountaineer, buckwheat, horsetail, madder dye and the thick extracts obtained from them, the quantitative content of the following trace elements was calculated: iron, manganese, copper, zinc, selenium, chromium and cobalt. Conclusion. As a result of the conducted research, a comparative quantitative analysis of trace elements in raw materials and thick extracts was carried out, and methods with a high yield of trace elements in extracts were proposed.
Keywords: atomic absorption spectrometry, chemical elements, minerals, medicinal plants
COST-UTILITY ANALYSIS OF TOCILIZUMAB THERAPY FOR RHEUMATOID ARTHRITIS IN COMPARISON WITH OTHER BIOLOGICAL DRUGS
Gerasimova D.A., Kondratyuk P.A., Gerasimova E.V., Zaharova O.V., Lobuteva L.A., Popkova T.V.
Abstract: Objectives. To evaluate the clinical and economic effectiveness of tocilizumab (TCZ) therapy for RA in comparison with other types of biologic drugs using a «cost-utility» model. Methods. 56 patients with active RA (DAS28˃5.1) were included in the study. The patients were divided into 2 groups: group 1 included patients (n=30) receiving TZC; patients in group 2 (n=26) were prescribed other biologics (rituximab (n=17), etanercept (n=6), adalimumab (n=3). All patients were determined by the DAS28 disease activity index and quality of life (QOL) using the EQ-5D-3L questionnaire upon inclusion in a study and after 12 months of therapy. The effectiveness of therapy was assessed using the generally accepted RA activity index DAS28 and the dynamics of this measure. The clinical and economic effectiveness of comparative therapies was determined by the cost-utility analysis (CUA) according to the model that we have developed. Results. A significant decrease in RA activity was noted in both groups: in group 1 DAS28 decreased from 6.1 [5.3;6.4] to 2.2 [1.8;2.9], p<0.001; in group 2 - from 5.9 [5.2;6.4] to 4.1 [3.3;4.8], p=0.03, despite this, the QOL indicator in both groups changed insignificantly: ΔQALY was 0.041 and 0.021, respectively. The smallest additional costs per 1 QALY were obtained in the case of using TCZ (16.2 million rubles). At the same time, the ICUR calculation demonstrated that the use of TCZ will require additional costs in the amount of 14.2 million rubles for each additional year of quality life of the patient in comparison with alternative therapy. This ICUR value exceeds the WTP of Russian society by 4 times. Conclusion. The study demonstrated a decrease in RA activity and no changes in patients' QoL on the background of 12-month therapy with TCZ and other biologic drugs. This affected the results of the CUA, which found that short-term use of biologic therapy was economically inappropriate. Analysis with increasing number of patients and duration of therapy will allow to assess the clinical and economic feasibility of using biologic drugs in RA patients
Keywords: rheumatoid arthritis, quality-adjusted life year, genetic engineering biological agents, EQ-5D-3L, cost-utility, DAS28
ANNIVERSARIES
LYUDMILA VYACHESLAVOVNA KOZLOVA: TO THE ANNIVERSARY OF THE PEDIATRICIAN, TEACHER, SCIENTIST, PUBLIC FIGURE
Bekezin V.V., Peresetskaya O.V., Nagornaya S.V.
Abstract: On the occasion of Lyudmila Vyacheslavovna Kozlova's 75th anniversary, the article provides a brief overview of her life path and significant contribution as a teacher and scientist to Russian medical education and medical science; as a pediatrician and public figure to the development of the Smolensk Pediatric School and practical healthcare in Russia.
Keywords: Kozlova L.V., doctor, scientist, teacher, public figure, anniversary/p>
ASSOCIATE PROFESSOR PETR IVANOVICH PODCHEKO (TO THE 90 TH ANNIVERSARY OF BIRTHDAY)
Udovikova O.I., Ivanishkina E.V.
Abstract: January 6, 2024 marked the 90th anniversary of the birth of Pyotr Ivanovich Podcheko, associate professor of the Department of Propaedeutics of Internal Diseases of SSMU, who devoted his entire life to the noble cause of training future doctors, devoting a lot of effort and his pedagogical talent to higher medical school.
Keywords: Piotr Ivanovich Podcheko, 90th anniversary