Keratitis–ichthyosis–deafness syndrome (KID syndrome) is an extremely rare inherited form of genodermatosis characterized by a classic clinical triad: severe bilateral sensorineural hearing loss; cutaneous manifestations, including palmoplantar hyperkeratosis, keratoderma with skin granularity, nail dystrophy, alopecia, and ichthyosiform scaling; and vascularizing keratitis. Currently, approximately 100 cases of this disorder have been reported worldwide. Corneal involvement in KID syndrome is highly polymorphic regarding severity, extent, and degree of vascularization, ranging from early signs of limbal stem cell deficiency to severe total corneal opacification with active neovascularization. This variability complicates follow-up management and limits surgical treatment options for corneal leukoma in affected patients. This report presents the clinical features of KID syndrome in a 6-year-old boy, with emphasis on the spectrum of ophthalmic and dermatologic manifestations. Characteristic ocular changes associated with KID syndrome developed at a relatively early age and resulted in marked visual impairment due to loss of optical media transparency; these changes were partially reversible with timely administration of keratoprotective therapy. We describe a diagnostic protocol to evaluate visual function in patients with early and pronounced ocular manifestations of KID syndrome. At present, ophthalmic manifestations of KID syndrome remain one of the least studied aspects of the disease spectrum. A distinctive feature of this case is the earlier onset of ophthalmic manifestations compared with previously reported cases. The scientific base of such publications should be expanded to establish unified approaches to the monitoring and treatment of these patients, aiming to prevent irreversible vision loss.
Mild traumatic brain injury (MTBI) is a serious public health problem due to its relatively high prevalence (1.0-1.2% per 100,000 people). The aim of this review is to analyze current approaches to the diagnosis and restorative treatment of functional visual impairment in patients with MTBI. The analysis showed that patients with MTBI exhibit clinical signs of impaired accommodative function (30-80% of cases) and convergence (32-40%), photosensitivity (50-55%), impaired saccadic and pursuit eye movements (30-60%), and the development (or worsening) of dry eye syndrome symptoms. Foreign ophthalmologists recommend a comprehensive treatment and rehabilitation program for patients with functional visual impairments after MCBI, based on optical correction (including prismatic correction), binasal occlusion, and outpatient and/or home accommodation and convergence training using specialized computer programs and mini-simulators (e.g., targeted eye movement exercises). In domestic ophthalmology practice, a set of specific physiotherapeutic methods for visual stimulation is used for accommodation disorders (in a specialized office), taking into account a differentiated approach depending on the type of accommodative asthenopia. However, this approach, as applied to patients with MCBI, requires further study. The practical feasibility of early restorative treatment for vision after mild traumatic brain injury (MTBI) reflects a medical and social model of health, which posits that the goal of treatment is the rapid return of the patient to daily activities with pre-injury performance levels. This, especially for patients with visually demanding jobs, will ensure the achievement of the required level of visual performance and prolong professional longevity.
Hypertension is a global public health problem. According to the World Health Organization (September 2025 data), at least 1.4 billion adults aged 30–79 years worldwide live with this condition. However, only 44% of patients receive treatment, and effective disease control (defined as achieving standard target blood pressure [BP] levels) is achieved in just 23% of those requiring therapy. This highlights the necessity of enhancing out-of-hospital blood pressure monitoring through the development of innovative digital remote systems. This review aimed to identify the key characteristics of international digital systems for BP monitoring, including mobile applications, messengers, chatbots, artificial intelligence–based platforms, and smart devices. The work is based on an in-depth analysis of 38 substantial publications selected using Google ecosystem tools and relevant search queries in the PubMed database. Digital technologies for BP monitoring are implemented using solutions that include automated BP measurement and recording systems, telemonitoring, remote patient communication tools, and computer-based medical data processing. The implementation of these technologies considerably expands the capabilities for monitoring and follow-up of patients with hypertension, surpassing traditional methods. However, their widespread adoption requires technical device validation, standardization of application methodologies, training of personnel and patients, and additional research in real-world clinical settings.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic condition, with an estimated global prevalence of 32% and rates reaching 37–42% in the Russian Federation. The disease is recognized as an independent risk factor for cardiovascular disease (CVD), which remains the leading cause of mortality in this patient population. This review aims to systematize current evidence on the association between MASLD and CVD, risk stratification approaches, and contemporary therapeutic strategies to mitigate the risk of severe cardiovascular complications within the Russian population. A literature search was conducted in the PubMed/Medline, ScienceDirect, eLibrary, and Google Scholar databases covering the period from 2020 to 2025. A total of 67 publications meeting the inclusion criteria were incorporated into this review. The analysis highlights the pivotal roles of insulin resistance, visceral obesity, systemic inflammation, dyslipidemia, and dysregulation of the gut–liver–heart axis in shaping cardiovascular risk. Liver fibrosis, defined by a FIB-4 index ≥1.3, serves as an independent predictor of CVD, conferring a two-fold increase in risk. MASLD is associated with a 2.19-fold higher risk of coronary heart disease, a 1.88-fold higher risk of stroke, and a 20% increased risk of atrial fibrillation. A stepwise risk stratification algorithm tailored to the Russian healthcare system is proposed, incorporating initial screening (using FLI or CMI), fibrosis assessment (FIB-4), advanced diagnostic refinement, and integration with established cardiovascular risk scales (SCORE2, ACC/AHA). The efficacy of non-pharmacological interventions, including weight reduction of ≥7–10%, adherence to a Mediterranean diet, and regular physical activity, is substantiated by meta-analytic data. Among pharmacological agents, GLP-1 receptor agonists (reducing CVD risk by 17%), SGLT2 inhibitors (improving survival rates to 95%), pioglitazone, and statins (lowering hepatocellular carcinoma risk by 48%) demonstrate robust cardioprotective effects. Emerging avenues include combination therapy with novel agents (resmetirom, efruxifermin) and the application of machine learning algorithms for personalized risk prediction. Identified gaps include a paucity of domestic randomized controlled trials and the absence of a dedicated national MASLD–CVD registry. The findings underscore the necessity of integrating screening protocols into routine preventive health examinations, developing regional patient referral pathways, and enhancing the competency of primary care physicians.
Background. Iron deficiency (ID) is the leading cause of anaemia worldwide and a potentially significant risk factor for cognitive impairment in adults. Despite accumulating evidence, systematic data on the effects of iron-deficient states on cognitive functioning in the adult population remain limited. The objective of this review was to systematically analyse original clinical studies published over the past five years examining cognitive impairment in adults with iron deficiency anaemia (IDA) and ID without anaemia. Methods. Original studies were included if they enrolled adults (≥18 years) with a laboratory-confirmed diagnosis of IDA or ID according to WHO criteria and assessed cognitive function using validated neuropsychological instruments (MMSE, MoCA, WAIS-IV, Digit Span, etc.); studies conducted in paediatric populations were excluded. Searches were performed in PubMed, Google Scholar, and eLibrary, supplemented by manual reference screening. Methodological quality was assessed using the Newcastle–Ottawa Scale by two independent reviewers. Given the heterogeneity of study designs, a narrative synthesis approach was applied. Results. Of 294 identified publications, 9 studies met the inclusion criteria. All included studies demonstrated a significant association between IDA/ID and impairment of memory, attention, information processing speed, and executive function. The severity of cognitive deficit correlated with the degree of anaemia. Neurophysiological and neuroimaging data (event-related potentials, resting-state fMRI) confirmed functional impairment of the central nervous system. Available evidence on the efficacy of iron supplementation suggests that cognitive deficits are reversible with timely treatment. Discussion. The findings are consistent with the existing body of evidence and indicate that cognitive impairment associated with iron deficiency may be reversible when treatment is initiated promptly. Prospective randomised studies employing standardised cognitive assessment protocols are warranted. Limitations of this review include the predominance of cross-sectional studies with small sample sizes, heterogeneity of diagnostic criteria and neuropsychological instruments, and a limited number of interventional studies.
Introduction. Congenital hypertrophic pyloric stenosis is one of the most common pathologies in the neonatal period and the first months of life, requiring urgent surgical treatment. For a long time, the standard treatment was open pyloromyotomy (Ramstedt stenosis), performed through a laparotomy. However, with the development of minimally invasive surgical techniques, laparoscopic pyloromyotomy (LP) has become widespread. Despite the widespread use of LP, questions remain regarding its comparative effectiveness and safety in modern pediatric surgery. Materials and Methods. The authors conducted a systematic search of publications in PubMed, Science Direct, eLIBRARY, and Google Scholar databases in Russian and English for the period from 2010 to 2025. The risk of bias was assessed using the Cochrane RoB 2 and ROBINS-I tools. A random-effects model was used for quantitative data synthesis, assessing outcomes such as surgical duration, hospital stay, and the risk of intraoperative duodenal mucosal perforation. Results. Data from 9 studies were included in the meta-analysis. No statistically significant differences were found between LP and OP for the primary outcomes: the pooled mean difference for operation duration was -1.62 minutes (95% CI: -17.39 to 14.15; p=0.765), for length of hospital stay it was -1.06 days (95% CI: -2.59 to 0.47; p=0.115), and the pooled relative risk for intraoperative mucosal perforation was 1.26 (95% CI: 0.45–3.57; p=0.587). At the same time, extremely high statistical heterogeneity was observed for continuous outcomes (I² 90%). The overall certainty of evidence, assessed using the GRADE methodology, was low. Conclusions. The results of the systematic review and meta-analysis, based on quantitative synthesis, do not allow for a definitive conclusion regarding the superiority of LP or OP for key perioperative outcomes. However, a comprehensive analysis of qualitative data demonstrates that LP is associated with a comparable safety profile, as well as a number of potentially clinically significant benefits, such as reduced pain severity, early recovery and transition to enteral feeding, and improved cosmetic results.
BACKGROUND: The role of serum immunoglobulin A is often underestimated; however, its functions in systemic protection and endotoxin clearance make it an important marker of the “cost of adaptation.” Serum immunoglobulin A concentration depends on sex and age, but the influence of contrast climate and the specifics of non-contact injury during the off-season has not been thoroughly studied before. AIM: To assess the influence of climatic factors and the specifics of non-contact injury on the variability of serum immunoglobulin A levels, taking into account age and sex, in elite athletes during the off-season. METHODS: A retrospective analysis of data from 7549 athletes (mean age 19.98 years) was performed. Comparative pairs were formed: “Biathlon–Triathlon” (climate influence with similar energy expenditure) and “Figure Skating–Speed Skating” (influence of biomechanics and injury patterns). Serum immunoglobulin A levels were measured using immunochemiluminescence analysis (g/L). Statistical analysis included estimation of 95% confidence intervals and neural network modeling (multilayer perceptron) to assess the contribution of factors. RESULTS: Reduced serum IgA levels were observed in athletes participating in winter and impact-loading sports. In biathletes, the level (1.67 g/L) was lower than in triathletes (1.73 g/L); the weight of the cold factor was –0.443. The minimum value was recorded in figure skating (1.40 g/L), which was significantly lower than that in speed skating (1.68 g/L). Modeling showed that impact loads (weight: –0.548) were associated with a lower level of serum immunoglobulin A. Sexual dimorphism (males females) and positive age-related trends were confirmed. CONCLUSION: Serum immunoglobulin A serves as a sensitive integrated marker of allostatic load. Cold stress and chronic trauma resulting from impact loads act as independent factors contributing to its reduction. The risk group includes female and young athletes specializing in complex coordination and winter sports.
The presented clinical case is devoted to the problem of rehabilitation of patients with postextractional atrophy of the mandible, in which standard protocols of implantation treatment are of limited use due to unfavorable qualitative characteristics of bone tissue and features of the anatomy of the alveolar ridge. Despite the accumulated clinical experience in the field of simultaneous implantation and immediate loading, the issue of their use in conditions of reduced bone density and the need for rapid functional stabilization without extended laboratory steps remains insufficiently addressed. This circumstance served as the basis for the publication of this observation, demonstrating an alternative clinical approach to solving this problem and its practical feasibility. The clinical case describes a patient with partial mandibular adentia and a long history of tooth loss. The clinical situation was complicated by the limited possibilities of achieving implant stability with traditional single-stage implantation schemes. A protocol for the installation of implants with an immediate functional load was chosen, including the manufacture of a temporary orthopedic structure and introoral welding of a metal frame for rigid integration of the implants. The orthopedic design was adapted directly into the oral cavity with subsequent relocation. In the early postoperative period, satisfactory primary stabilization was achieved, chewing function was restored and an acceptable functional and aesthetic result was achieved without signs of complications. The conclusion of this clinical observation emphasizes that under unfavorable anatomical and clinical conditions, the key success factor may be not so much the absolute volume of bone as the possibility of early mechanical stabilization of implants and control of micro-mobility. The use of introoral welding makes it possible to shorten the duration of treatment and minimize the number of stages, however, it requires high accuracy and strict selection of patients. The results obtained should not be directly extrapolated to broad groups of patients, but they demonstrate the potential of this approach as one of the treatment options in complex clinical situations.
Postoperative pain following major joint orthopedic surgery remains a significant cause of delayed rehabilitation, repeated opioid administration, and patient dissatisfaction with treatment outcomes. Peripheral nerve blocks reduce pain intensity and the need for opioid analgesics; however, the duration of action of local anesthetics administered as a single injection does not always cover the period of the most severe pain. Accordingly, interest persists in adjuvants added to local anesthetics to enhance and prolong analgesia. An analytical review of publications from PubMed/MEDLINE, ScienceDirect, Scopus, and eLIBRARY.RU was conducted for the period from January 2020 to March 2026; earlier sources were included where relevant to understanding the methodology or clinical context. The review was prepared in accordance with the SANRA criteria. Primary attention was devoted to studies evaluating dexamethasone, dexmedetomidine, nalbuphine, and magnesium sulfate in peripheral nerve blocks, as well as to works comparing single-injection and continuous techniques. Dexamethasone and dexmedetomidine remain the most extensively studied agents. Dexamethasone has a more favorable safety profile, prolongs the duration of analgesia, and may reduce the severity of rebound pain. Dexmedetomidine reduces opioid requirements but is more frequently associated with hypotension, bradycardia, and sedation. Data on nalbuphine and magnesium sulfate have largely been obtained from upper extremity blocks and cannot be directly extrapolated to major lower limb joint surgery. The choice of adjuvant should take into account not only the duration of blockade but also safety, the impact on motor function, the route of administration, the regulatory status of the agent, and the goals of postoperative rehabilitation.
Aim.To analyze and systematize current data on the capabilities of FDG-PET in the differential diagnosis of major neurodegenerative diseases leading to dementia, and to develop a framework for a practical algorithm for the visual assessment of hypometabolism patterns. Eligibility criteria.Publications containing original data and/or a synthesizing analysis on the use of FDG-PET for the differential diagnosis of major forms of dementia were included. Eligible publications comprised original studies, clinically relevant systematic reviews and meta-analyses, clinical guidelines, studies with publicly accessible full texts in English and/or Russian, and papers published in peer-reviewed scientific journals. Duplicate publications, papers without accessible full texts, single case reports, conference abstracts, expert opinions lacking systematized data or meta-analysis, dissertations, patents, and publications in languages other than Russian and English were excluded. Information sources.The literature search was conducted over a five-month period, from June 2025 to October 2025, in international and Russian bibliographic databases: PubMed/MEDLINE, ScienceDirect, Google Scholar, and eLIBRARY. The search depth was 7 years, from 2019 to 2025. Risk of bias.Risk of bias assessment for individual studies was not performed due to the high heterogeneity of the included studies. Synthesis of results.The present review analyzes the methodology and diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in the differential diagnosis of the major neurodegenerative diseases (NDDs) leading to dementia. Included studies.The primary search yielded 1221 publications: 518 from PubMed/MEDLINE, 387 from ScienceDirect, 256 from Google Scholar, and 60 from eLIBRARY. The final sample for the review included 60 publications. Results of the synthesis.The pathophysiological basis of the method is the assessment of glucose uptake as a biomarker of neuronal metabolic activity, which is closely linked to synaptic function. The review characterizes specific hypometabolism patterns: in Alzheimer's disease (AD), hypometabolism is observed in the temporoparietal cortical regions and the posterior cingulate gyrus/precuneus; in frontotemporal dementia (FTD), involvement of the frontal lobes and the anterior cingulate gyrus is characteristic; and in dementia with Lewy bodies (DLB), the key feature is hypometabolism in the occipital lobe, particularly in the primary visual cortex, with relative sparing of the posterior cingulate gyrus. Current algorithms for interpreting FDG-PET data are discussed separately, including systematic visual analysis and semi-quantitative methods such as statistical parametric mapping (SPM), which enhance the diagnostic accuracy of the technique. Limitations of the evidence.Despite high diagnostic performance, limitations of the method related to the overlapping of metabolic patterns in mixed pathologies have been identified. Hypometabolism is not an absolutely specific marker of irreversible neurodegeneration and must be interpreted in conjunction with the clinical presentation. Interpretation.The importance of standardizing the imaging protocol, controlling blood glucose levels, and standardizing scanning conditions to ensure result reliability is highlighted. The need for an integrative approach combining FDG-PET data with the clinical picture, MRI, and, in complex cases, with molecular analysis and cerebrospinal fluid biomarkers is also substantiated. Taken together, this makes it possible to minimize diagnostic errors and lay the foundation for a personalized approach to the management of patients with NDDs. Funding.No funding sources were provided. Registration.The protocol was not registered.
Chromosomal instability (CIN) is a hallmark of a wide range of malignant neoplasms and is characterized by an increased frequency of chromosome segregation errors during mitosis. Its presence correlates with aggressive clinical behavior, drug resistance, and reduced patient survival. At the same time, CIN creates a functional dependency of tumor cells on a limited number of regulatory pathways that maintain residual mitotic fidelity, providing a rationale for selective therapeutic intervention. In recent years, there has been growing interest in targeting components of the mitotic machinery that are critical under CIN conditions. One such target of ongoing research is the protein KIF18A, which is being considered as a potential therapeutic target in tumors with unstable karyotypes. This study aims to substantiate the therapeutic relevance of KIF18A in chromosomally unstable tumors and to review current experimental approaches to its inhibition, which are in preclinical and early clinical stages of development.
High-energy pelvic fractures represent a considerable challenge in modern traumatology and orthopedics, associated with a high risk of massive blood loss, thromboembolism, neurological deficits, and prolonged lоss of function. Unstable, comminuted fractures pose a particular difficulty, requiring not only early stabilization but also precise anatomical reductiоn of all elements of the pelvic ring. Achieving proper fragment alignment, especially in cases of vertical and rotational displacement, remains a complex task. Open surgical approaches are associated with significant blood loss, risk of damage to neurovascular structures, and infectious complications, highlighting the need for the development of minimally invasive techniques. This article describes the clinical experience of intraoperative application of a pelvic reduction frame for anatomical reduction in a comminuted pelvic fracture, as well as an assessment of rehabilitation outcomes, long-term functional results, and patient quality of life. We present a clinical case оf a 39-year-old patient who sustained multiple pelvic fractures due to a fall from height. The article demonstrates the use оf an intraoperative pelvic reduction frame (hereinafter referred to as the “pelvic frame”) during closed reduction and osteosynthesis of the pelvic ring, which facilitated early patient verticalization and led to good functional outcomes (Majeed score 88, Oxford Hip Score 52). This clinical case confirms the effectiveness of using a pelvic frame in the treatment of complex, vertically unstable pelvic fractures. The methоd provided accurate closed reduction and stable fixation without the need for extensive surgical approaches. This, in turn, enabled early mobilization and a favorable long-term functional result.
Pupillary reflex parameters reflect the functional state of the visual pathway and the nervous system as a whole. An accurate, objective, and easily reproducible method for assessing these parameters is pupillometry—a quantitative analysis of pupillary response dynamics to light stimulation. We searched the international PubMed and EMBASE databases as well as the Russian eLIBRARY.RU database, identifying case reports, original research studies, and systematic reviews. Current research demonstrates growing interest in pupillometry as a diagnostic method for pupillary abnormalities in ophthalmological and neurological diseases. Previously used primarily in neurology, it has been actively introduced into ophthalmological practice in recent years. Moreover, pupillometry demonstrates high sensitivity to early ophthalmological changes in conditions such as age-related macular degeneration, glaucoma, and diabetic retinopathy—changes that often precede structural damage detected by optical coherence tomography or perimetry. Additionally, in unilateral optic nerve lesions, pupillometry enables the identification of compensatory mechanisms in the healthy eye, driven by adaptation of intrinsically photosensitive retinal ganglion cells (ipRGCs). Studies show that quantitative pupillary reflex parameters and derived indices are successfully used for diagnosis, prognosis, and treatment selection in brain lesions. Pupillometry not only helps identify post-stroke complications but also aids in suspecting stroke during emergency care, predicting outcomes of traumatic brain injury, optimizing treatment, and monitoring brain function recovery. Automated pupillometry holds promise for the diagnosis and monitoring of both ophthalmological and neurological diseases. Further research will expand its application and improve data analysis algorithms.
Periodontitis remains one of the leading causes of tooth loss, with disruption of microbial balance in the oral cavity considered a key mechanism in its pathogenesis. In recent years, growing interest has focused on the oral microbiota as a therapeutic target, highlighting the relevance of analyzing current approaches aimed at restoring microbial balance and reducing inflammatory activity. The review aimed to evaluate the effectiveness of probiotics, prebiotics, and other microbiota-modulating interventions in periodontitis. An analysis of publications from 2020 to 2025, including clinical studies and reviews, demonstrated that the use of probiotics (Lactobacillus reuteri, L. salivarius, Bifidobacterium spp.) and prebiotics (inulin) is associated with a reduction in periodontal pocket depth, decreased gingival bleeding, normalization of microbial composition, and reduced levels of proinflammatory cytokines. The most pronounced clinical effect was observed when these agents were combined with conventional mechanical debridement of root surfaces. The available evidence indicates that modulation of the oral microbiota represents an effective and safe adjunctive approach in the treatment of periodontitis. This review systematizes current data on the use of probiotics and prebiotics in dentistry and identifies promising directions for future clinical research aimed at optimizing treatment protocols.
This review summarizes data on the morphological and molecular characteristics of the tumor microenvironment (TME) of synovial sarcoma and shows how the integration of these parameters can be used for choosing personalized treatment. Publications from 2015–2025 (with priority given to 2023–2025) were analyzed across key areas: tumor immune landscape; stromal and vascular components; spatial organization of the TME; epigenetic regulation and therapeutic strategies, including Tcell receptorbased approaches; as well as data from multiplex immunomorphology, singlecell and spatial transcriptomic profiling, and clinical studies of immunotherapy. The TME of synovial sarcoma was found to be highly heterogeneous and often immunologically “cold,” with limited effector T cell infiltration and a predominance of immunosuppressive myeloid populations (macrophages / myeloid-derived suppressor cells); however, a subset of cases shows signs of T cell inflammation that may predict response to treatment. Modern spatial approaches and single-cell RNA sequencing refine the compartmentalization of the TME and identify cellular states of tumor cells and stroma associated with invasion and resistance. Key personalization directions include: (1) stratification by antigen expression (NY-ESO-1, MAGE-A4, PRAME) and antigen presentation status; (2) combining T cell receptor-based therapy with TME modulators (epigenetic drugs, signaling pathway inhibitors, anti-angiogenic/anti-fibrotic strategies); and (3) digital TME morphometry using whole-slide images (WSI) as a reproducible source of biomarkers. Thus, the integration of morphological, immune, and molecular characteristics of the TME forms the basis for practice-oriented stratification of patients with synovial sarcoma and rational selection of personalized therapeutic combinations.
Chronic heart failure (CHF) is a common syndrome that develops as a result of almost any organic pathology of the cardiovascular system. The high risk of hospitalization, disability, and mortality in CHF creates a significant burden on health care systems and is accompanied by high economic costs. Currently, the main principles of managing patients with CHF are focused on creating a neurohumoral blockade and regulating the volume of circulating blood. At the same time, the nutritional status of patients is often ignored. This approach is based on the lack of large-scale clinical studies on the correction of cachexia or sarcopenia in patients with CHF, as well as comprehensive nutritional recommendations for this category of patients. In patients with CHF, there are barriers to improving natural nutrition, but there is insufficient evidence to support the need for regular intake of any nutritional supplements in patients with CHF. However, some studies have shown that dietary interventions are useful for patients with CHF. The aim of this work was to search for literature data in the Russian scientific electronic library eLibrary.ru, as well as in the search engine for biomedical research PubMed for their generalization and the formation of ideas about the effectiveness of possible options for nutritional support in CHF. The review presents modern information on metabolic imbalance, the obesity paradox, the role of sodium, diets, and a number of food additives in CHF. Recent successful studies of nutritional correction in patients with CHF, including those with sarcopenia and cachexia, are briefly analyzed. The importance of additional protein administration in the treatment of CHF is emphasized.
BACKGROUND: Despite the expansion of surgical techniques for correcting rectus abdominis diastasis (RAD), the selection of an optimal repair method remains debatable. Current approaches differ in the degree of tissue trauma, recurrence rates, and postoperative pain, while the prognostic role of preoperative ultrasound and electromyographic parameters has not been sufficiently studied. Establishing objective preoperative criteria could facilitate prediction of long-term outcomes and reduce the risk of complications following RAD repair combined with abdominoplasty. AIM: To evaluate the effectiveness of different RAD repair techniques performed concurrently with abdominoplasty and to determine the prognostic value of preoperative ultrasound and electromyography for long-term surgical outcomes. METHODS: This study included 86 female patients who underwent abdominoplasty with RAD repair between 2022 and 2024. Patients were assigned to three groups according to the repair technique: continuous suture, mesh placement with traditional fixation, and interaponeurotic mesh placement without fixation. All patients underwent preoperative and early postoperative ultrasound assessment (RAD size and aponeurosis thickness) and electromyographic evaluation of abdominal muscle bioelectric activity. RESULTS: Interaponeurotic mesh placement demonstrated the most favorable indicators of bioelectric muscle activity and the lowest incidence of chronic pain. Recurrence of RAD (30%) was recorded exclusively in the continuous suture group. Early postoperative complications were comparable across groups. Preoperative ultrasound and electromyography parameters correlated with the likelihood of long-term complications and may serve as predictive markers for surgical outcomes. CONCLUSION: Preoperative ultrasound and electromyographic assessment enables prediction of long-term outcomes of RAD repair combined with abdominoplasty and supports informed selection of the optimal surgical technique. Interaponeurotic mesh placement without fixation appears to be an effective alternative associated with fewer long-term complications, though further research is required to confirm its long-term safety.
BACKGROUND: Access to dental care for people experiencing homelessness remains a significant challenge in healthcare organization due to social, organizational, and legal barriers. In the context of limited engagement of this population in planned medical care, the analysis of process indicators in specialized socially oriented settings is particularly relevant. AIM: To characterize process indicators of dental care delivery to homeless individuals in a specialized socially oriented dental clinic. METHODS: A retrospective observational study was conducted using anonymized medical records from a specialized clinic for the period 2022–2025. Socio-demographic characteristics, service utilization, volume and structure of dental procedures, repeat visits, and contacts across different calendar years were analyzed. The analysis was descriptive and included absolute and relative values, medians, and interquartile ranges. RESULTS: Data from 547 patients were analyzed. The cohort was socially heterogeneous in terms of living conditions and availability of identity documents. Changes in the number of unique patients, total visits, and dental procedures were observed across the study years. The structure of care included diagnostic, surgical, therapeutic, and preventive procedures, with variations over time. A proportion of patients had repeated visits, including contacts in two or more calendar years. CONCLUSION: The findings describe organizational features of dental care delivery to homeless individuals in a specialized socially oriented clinic and may be used for planning and analyzing care models for socially vulnerable populations. Study limitations are related to the retrospective design and single-clinic data.
Central serous chorioretinopathy (CSC) is characterized by focal dysfunction of the retinal pigment epithelium with choroidal vascular hyperpermeability leading to accumulation of subretinal fluid with serous detachment of the neurosensory retina, usually with retinal pigment epithelium detachments, defects or other alterations. The study of CSC is closely linked with the use of optical coherence tomography (OCT) and OCT-angiography to make the diagnosis, eliminate the complications, determine the tactics of patient management and subsequent follow-up. According to the conducted search and analytical work, it is important to state that many issues have not been fully understood despite the numerous studies in the field of OCT-diagnostics in CSC. For example, the criteria of acute and chronic CSC, the possibilities of OCT for identifying of the supposed leakage point and detection of choroidal neovascularization require further study. Continued research is required to determine the criteria for CSC progression, recurrence, positive and negative treatment response and development of complications. The study of OCT-biomarkers is relevant in order to systematize approaches to the diagnosis and management of CSC. The clinical application of OCT-biomarkers has expanded, due to a variety of recent clinical studies. OCT-biomarkers for recurrence, predictive and prognostic OCT-biomarkers fora positive and negative outcomes are determined. Thus, the main practical significance of OCT-biomarkers is the future possibility to manage the patients using the individual characteristics of the disease, providing a personalized approach.
BACKGROUND: The growing proportion of older adults has led to an increase in trauma incidence, mainly low-energy osteoporotic fractures, placing a substantial burden on the healthcare system. Despite the high prevalence of this problem, Russian data on structure, seasonal variability and clinical-organizational aspects of emergency care for such patients remain scarce. AIM: To assess the structure and clinical characteristics of trauma in elderly patients admitted on an emergency basis, identify factors influencing the course and outcomes of traumatic disease, and analyze treatment strategies depending on the severity of comorbid conditions. METHODS: A retrospective single-center observational study was performed. The analysis included 3 588 patients aged ≥ 56 years who were urgently admitted to the trauma department of a multidisciplinary hospital (Moscow) from 2021 to 2024. RESULTS: Women accounted for 67.9% of the sample (n = 2,438), with a mean patient age of 72.7 ± 10.0 years. The highest number of hospitalizations was recorded in winter (32.3%). Low-energy fractures predominated, primarily of the proximal femur (33.2%) and the proximal humerus (17.1%). Comorbidities were identified in 85.9% of patients, most commonly arterial hypertension (35.5%) and chronic heart failure (19.2%). The mean hospital stay was 10.7 ± 9.2 days, increasing with age and in cases of polytrauma. The primary outcome — in-hospital mortality — was 5.3% (95% CI 4.6–6.1), with 190 deaths (135 women and 55 men). CONCLUSION: The study confirmed the high prevalence of severe osteoporotic injuries among the elderly during emergency hospitalization. Timely surgical intervention and a multidisciplinary approach are associated with better clinical outcomes. The findings underscore the need for dedicated geriatric trauma pathways and optimized resource allocation.
