ntroduction. Dental diseases are widespread among all ages and strata of the population, including among the population living within the Russian Federation. Dental morbidity among the child population does not have a downward trend, either. Its prevalence and intensity progress with the child’s age and entail complications in other body organs and systems. The existing prevention programs do not provide any lasting reduction in the prevalence of major dental diseases among those at highest risk of their occurrence. When taking preventive measures, it is necessary to consider the age and type of the child’s family, since their domestic relations and family typology have a direct impact on the development of the child’s psychological and physical health. At the same time, the antenatal period is an important stage in the child’s intrauterine development, it is in this period where body organs and systems are evolving and formed. Unfavorable pregnancy course and the adverse effects of socio-hygienic risk factors lead to the development of pathology in the child, including dental pathologies, such as multiple dental caries, formation of dentoalveolar anomalies, and non-carious dental diseases. Aim . To analyze the results of medical and social prevention of dental caries in preschool children, depending on the type of family and on the impact of socio-hygienic risk factors.Materials and Methods. As part of the study, a family survey of women and children from different types of families was carried out, socio-hygienic factors of the antenatal period were found, and their impact by the type of family relations. Conclusions . The findings of the study demonstrate the influence of family relationship typology on the incidence of dental caries among preschool children, as well as on the impact of risk factors in the antenatal period. At the same time, we have obtained data on a decrease in the prevalence of dental caries after a prevention program, considering the type of the child’s family and the influence of socio-hygienic factors.
Introduction. Autism spectrum disorders are a group of neuropsychiatric conditions with complex pathogenesis involving genetic, epigenetic, and metabolic factors. One of the key elements actively studied in recent years is the balance of trace elements. Disruptions in this balance may contribute to the development of neuroinflammatory and oxidative processes characteristic of autism spectrum disorders. Aim. To analyze current scientific literature on trace element metabolism disorders in autism and assess their contribution to the pathogenesis of autism spectrum disorders . Materials and Methods . A literature search was conducted in databases, such as PubMed, Scopus, eLibrary, and Google Scholar, covering the period from 2014 to 2025. The selection included original studies containing data on the concentrations of zinc, copper, selenium, magnesium, iron, as well as lead, cadmium, mercury, and arsenic in children with autism spectrum disorders. Differences between autism spectrum disorders and control groups were assessed, along with potential clinical correlations. Results and Discussion. Cumulative data indicate a consistent decrease in zinc, magnesium, selenium, and iron levels in children with autism spectrum disorders. The most reproducible biomarker appears to be a reduced Zn/Cu ratio, which is associated with the severity of autistic symptoms. Data on toxic metals are inconsistent, i.e., some studies show increased levels, others report decreased urinary excretion, potentially indicating impaired detoxification and elimination processes. Correlational analyses in several studies revealed associations between trace element imbalance and symptom severity in autism spectrum disorders. Conclusions. The available evidence supports the involvement of trace element imbalance in the pathogenesis of autism spectrum disorders. Altered levels of zinc, copper, and antioxidant elements, as well as the specific patterns of accumulation and elimination of toxic metals, may act as additional biomarkers and targets for personalized intervention. It is still a promising trend to perform prospective multicenter studies with standardized methodologies for assessing trace element balance.
Introduction. Drug safety is a part of national security. An important task is to develop a full-cycle domestic pharmaceutical manufacture, including the production of local pharmaceutical substances. Aim. To study the local manufacturing content of pharmaceutical substances included in inhalation drugs. Materials and Methods. The study objects were data from the Common Register of the Authorized Medicinal Products registered within the EAEU, the State Register of Medicines, and scientific literature data. To identify the ratio of shares of domestic and foreign inhalation drugs and their dependence on the raw material origin, a methodology was used to assess the degree of the local content of drug production considering the country of origin of the pharmaceutical substance. Results and Discussion. The study showed that about 50% of domestic inhalation drugs are made from imported pharmaceutical substances, while 40% are fully imported. An analysis of data on the registration of inhalation drugs since 2022 has revealed that 86% of the brand names were registered for the first time. The main suppliers of pharmaceutical substances are India (66%) and Italy (22%). Only 3% of pharmaceutical substances are produced by domestic enterprises. A Pareto analysis has shown that 5 countries (India, Italy, the United Kingdom, Germany, and Switzerland) supply 78% of pharmaceutical substances. 61% of international non-proprietary names of pharmaceutical substances are registered in both the State Register of Medicines and the Common Register of the Authorized Medicinal Products registered within the EAEU. Conclusions. About 90% of inhalation drugs are manufactured from imported pharmaceutical substances, while only 1% of drugs are produced domestically from local pharmaceutical substances. A high demand was identified for establishing our local manufacturing content pharmaceutical substances to address the issue of import substitution.
Introduction. According to recent publications, the use of biological tissues in the repair of postoperative ventral hernias is a growing trend. Some researchers use autologous skin as a plastic material that, by preserving its tensimetric properties based on its pre-implantation preparation, integrates well with tissues and eliminates the negative consequences in the repair area, characteristic of allografts. Aim. To analyze the effectiveness of using deepithelialized autodermis prepared in an oxygenated perfluorane solution with an antibiotic before implantation, for strengthening the anatomical structures of the anterior abdominal wall in complex hernia repair. Materials and Methods. A chronic model of postoperative median hernia was experimentally created to test autodermis for inflammatory response and collagen formation. The prepared autodermis was tested for antimicrobial resistance to hospital strains of microorganisms. 35 patients with postoperative or recurrent hernias M1-M5 and W2-W3 were operated using deepithelialized autodermis. Age of the operated patients varied from 45 to 74 years. There were 14 men and 21 women. The area of the excised autologous skin graft after preparation and prior to implantation ranged within 525–1705 cm². Intraabdominal pressure was measured via a Foley urethral catheter. Computed tomography of the anterior abdominal wall was performed both before and after surgery. Results and Discussion. The created chronic model of median hernia after 30 days corresponded to a W3 hernia having an average diameter of 13.14 ± 1.33 cm (M ± m). The experiment showed that macroscopically, the implanted autologous skin is difficult to distinguish from the aponeurotic structures of the anterior abdominal wall. Histologically, after 30 days, lymphocytic infiltration was found at the autodermis implantation site, as well as fragmentation of collagen fibers and immature connective tissue with the formation of immature type III collagen. After 60 days, only isolated lymphocytic clusters remain. Under polarized light with Sirius Red staining, the transplant exhibits a red glow, indicating the formation of mature type I collagen. Out of 35 operated patients, complications were registered in 1 case (hematoma). CT monitoring from 1 to 24 months showed a tissue reaction ranging from mild infiltration to scar formation while preserving the anatomy of the anterior abdominal wall. The average length of stay was 8.5 ± 1.6 days. The time to return to work was 25.12 ± 2.1 days. No disease recurrence was observed within 5 years. Conclusions. The use of deepithelialized autodermis prepared as pre-implantation in an oxygenated perfluorane solution with an antibiotic, reduces the inflammatory process in the repair area, ensures the formation of type I collagen that promotes connective tissue formation, and reduces postoperative complications and disease recurrence.
Introduction. Currently, there are many publications dealing with the metabolic phenotypes of obesity. They are classified as metabolically healthy and unhealthy obesity . There are also m etabolically healthy and unhealthy normal weights. А im . To examine and analyze literary data on the problem of metabolically healthy obesity. Materials and Methods. Open-access publications were systematically searched for in the PubMed and Scopus databases, using the “metabolic healthy obesity” query. Data from reviews, original studies, and meta-analyses were included. The study identified the key aspects of metabolically healthy obesity causes, classification, diagnostic criteria, clinical characteristics, and treatment principles. Results and Discussion. An increase in one’s body mass index does not always correlate with a decline in cardiometabolic health. Fat accumulation and metabolic patterns vary based on genetic and acquired factors. The main healthy-obesity development principle is the preserved ability of the subcutaneous adipose tissue to accumulate triglycerides, preventing ectopic accumulation of fat. The core scientific vectors are aimed at identifying the predictors of transitioning from a metabolically favorable form of obesity to an unfavorable one, as well as at study - ing the relationship between obesity phenotypes and various diseases. Conclusions. Metabolically healthy obesity is a transient phenotype followed by the development of metabolically unhealthy obesity. It is important to prolong the patient’s metabolic health for as long as possible and to address factors that contribute to metabolic deterioration to reduce or prevent the risk of transition to a metabolically unfavorable state
Introduction. Intestinal ultrasound is a noninvasive tool used for monitoring disease activity in patients with Crohn’s disease, due to its low cost, safety, and availability. Although several ultrasound indices have been developed to assess activity, none have yet been fully validated. Aim. To evaluate the diagnostic value of ultrasound scores for determining ileitis activity in Crohn’s disease. Material and Methods. The study included 43 patients with ileitis in Crohn’s disease, including 33 (77%) in the acute stage and 10 (23%) in remission. Transabdominal ultrasound examination of the intestine was performed using a Sonoscape S2N device; the normal intestinal wall thickness was 3 mm. To assess Crohn’s disease ultrasonic activity, two indices were used: International Index of Ultrasound Segmental Activity of Intestinal Inflammation (IBUS-SAS) and the Simple Index of Ultrasound Activity of Crohn’s Disease (SUS-CD). Results and Discussion. During exacerbation of Crohn’s disease, the intestinal wall thickness (4.5 [3.73; 6] mm) was greater than in remission (3.05 [2.2; 3.6] mm, p=0.004). IBUS-SAS ultrasound index was higher during exacerbation of Crohn’s disease (43.2 [27.4; 71]) than the remission index (12.22 [8.8; 21.4], p=0.0006) and correlated with endoscopic activity (r=0.49; p<0.05) and fecal calprotectin level (r=0.68; p<0.05). IBUS-SAS index was a statistically significant predictor of Crohn’s disease activity for distinguishing between exacerbation and remission (AUC = 0.949; 95% CI: 0.836 – 0.993, p<0.0001) with a sensitivity of 88.2% and a specificity of 88.9%. SUS-CD index was higher in Crohn’s disease exacerbation (3 [2; 5]) than in remission (0 [0; 1], p=0.00006) and correlated with the IBUS-SAS index (r=0.97; p<0.05), endoscopic activity (r=0.54; p<0.05), and fecal calprotectin level (r=0.65; p<0.05). SUS-CD index was also a statistically significant predictor of Crohn’s disease activity for distinguishing between exacerbation and remission (AUC = 0.933; 95% CI: 0.813 - 0.987, p < 0.0001), with a cutoff value of 1, with the sensitivity of 76.5% and the specificity of 100%. Conclusions. A quantitative approach to assessing Crohn’s disease activity is provided by using the IBUS-SAS and SUS-CD ultrasound indices. Statistically significant differences in the values of these indices were found in the remission and exacerbation groups of Crohn’s disease; both indices correlated with endoscopic activity and the fecal calprotectin levels, the diagnostic value of the IBUS-SAS index being higher.
Introduction . In the context of the increasingly complex drug abuse situation and growing demands on the efficacy of rehabilitation programs, record-keeping systems based on retrospective reporting are proving insufficient for managerial decisions. Aim of this study is to present a cybernetically oriented dashboard of key performance indicators (KPIs) for monitoring drug user rehabilitation, enabling adaptive management at the service and throughout the region. Theoretically, the dashboard is based on S. Beer’s concept of the Viable System Model and W. Ashby’s law of requisite variety, allowing for the structuring of indicators across three management levels (L1–L3): Leading triggers, tactical retention indicators, and strategic clinical and social outcomes. Materials and Methods . Methodological framework includes a cohort design with a standardized index date, registry deduplication, watch time windows, censoring rules, and a flip-flop alert system. The digital implementation is represented by a three-layer architecture: A data layer based on FHIR events, a rule layer for calculating KPIs, and a web dashboard for displaying L1–L3 metrics. Results and Discussion . KPI dashboard is interpreted as a sensory circuit of a cybernetic system, doing the groundwork for predictive control and integrated into the PDCA (Plan–Do–Check–Act) cycle. Conclusions. The proposed model is shown to improve the manageability of the rehabilitation process, contribute to the reduction of blind spots in the care pathway, and it is consistent with international guidelines from the World Health Organization (WHO) and UNODC for monitoring the efficacy of drug addiction treatment and rehabilitation programs.
Introduction. Liver cirrhosis can develop resulting from chronic heart failure, which can be caused by various heart defects. This condition is called “cardiogenic cirrhosis.” There are types of palliative surgery for congenital heart defects. Blalock operation is a surgical procedure used to correct certain congenital heart defects. It involves creating a shunt between the artery that exits the heart and the pulmonary artery to improve blood supply to the lungs. Fontan procedure is used to surgically treat certain types of congenital heart defects, especially those associated with right- sided cardiac flow; it is conventionally used in children with conditions, such as tetralogy of Fallot or single-chamber heart. However, these interventions can lead to chronic venous hypertension, which often causes severe complications, including liver damage with progressive fibrosis. Aim. To present a clinical case of a patient with cardiogenic liver cirrhosis. Materials and Methods. Patient A., 39 years old, female, was hospitalized in the gastroenterology department of the Republican Clinical Hospital of Kazan with a diagnosis of liver cirrhosis of mixed etiology. It became known from the medical history that the patient has a congenital heart defect corrected by surgical interventions in her childhood (Blalock, Fontan). Considering the increasing edema and pronounced weakness, the patient was admitted for examination and therapy correction based on the interdisciplinary approach. Results and Discussion. This clinical case demonstrates the dynamics of clinical manifestations and laboratory and instrumental findings in a patient with congenital heart disease and advanced liver cirrhosis over several years. Conclusions. The case presented demonstrates the need for lifelong multidisciplinary monitoring of liver function in patients after surgery for congenital heart disease.
ntroduction. Developing a reasonable range of medications is an important component of ensuring the quality of pharmaceutical care in pharmacies. Antacid medications are a popular group for treating gastrointestinal diseases in children. Aim. To analyze the range of antacid medications approved for use in pediatric practice, available on the country-wide and regional pharmaceutical markets in Russia. Materials and Methods. The range of antacid medications was analyzed using data from the Unified Register of Medicines of the Eurasian Economic Union and the pharmacy product search and reservation website “yaVapteke.ru” (Voronezh, Russia). The following methods were used: Content analysis, structural analysis, comparison, and grouping methods. Results and Discussion. Russian pharmaceutical market offers nine different formulations of antacids approved for pediatric use, comprising the active ingredients of 49 trade names. Voronezh pharmacies offer all formulations of medications registered in Russia, and the majority (59.2%) of trade names. Domestic medications, primarily in liquid dosage forms, such as suspension and gel, predominate in the product range of the Russian country-wide and regional pharmaceutical markets. Only three formulations of the medications in this group are included in clinical guidelines describing the treatment regimens for children and adolescents. Age-specific differences have been established in antacid use, as outlined in clinical guidelines and the general characteristics of the medications. Conclusion. Pharmaceutical counseling plans for pharmacy customers purchasing antacid medications for children and adolescents must consider the age restrictions outlined in clinical guidelines. The current trend in improving the quality of pharmaceutical care is to develop a reasonable product range and counseling plans that provide recommendations for the selection and use of medications for children of various age groups.
Introduction. Long-term regular alcohol abuse leads to a non-specific inflammatory reaction in the mouth of and to some systemic diseases in the macroorganism. Aim. To evaluate the dental status with clinical, immunological and microbiological parameters of the mouth in alcohol-dependent patients undergoing various treatment regimens. Materials and Methods. Dental statuses were assessed in two study groups (n=42) with microbiome analysis using the Dentoscreen test system and cellular immunity indicators. Levels of lymphocytes, neutrophils and macrophages/ monocytes were evaluated based on the following treatment schemes: Braunodin+Prontosan and Braunodin+Emalan. Complaints, such as edema, hyperemia, pain, etc., and clinical data on GI, PMA, SBI, and CPITN indices were evaluated. Results and Discussion. Patients with alcohol dependence syndrome are characterized by a pronounced inflammatory picture (SBI index 50.0 (16.7; 5.0)) with a shift in immunological and microbiological parameters: Their levels of neutrophils increased (from 94.0 (89.0;97.0) to 99.0 (97.0;100.0) per 100 cells), the level of monocytes/ macrophages decreased 5-fold and lymphocytes 2-fold compared with reference values, Porphyromonas gingivalis prevailing with a high clinically significant titer (102000.0 (77000.0;136000.0) GE/ml. After treatment, the best results were observed 30 days later in both groups. Bleeding decreased from 7.0 (7.0;8.0) and 5 (4.0;6.0) days in groups 1 and 2, respectively (p<0.0001). PMA level decreased from 39 to 7%, SBI from 37.91 to 7%, GI from 1.8 to 0.35 points, CPITN from 2.7 to 1 point. Immunological and microbiological indicators decreased to reference values in both study groups. Conclusions . Thus, the effect of alcohol on the oral cavity contributes to the activation of immune system cells, changes in the level of P. gingivalis, which manifests itself in clinical signs of inflammation. At the same time, the treatment schemes Braunodin+Prontosan and Braunodin+Emalan show good results. However, according to clinical signs, the Braunodin+Emalan treatment scheme showed the best results.
Introduction. In autoimmune liver diseases, liver is transplanted in cases where conservative treatment is ineffective, and the disease leads to the liver function decompensation or to the development of liver cirrhosis of the liver with complications. Liver transplantation is one of the radical treatment options. Aim. To study the features of liver transplantation in autoimmune liver diseases. Materials and Methods. Literature sources were reviewed on liver transplantation in autoimmune diseases of various origins. Results and Discussion. Etiological factors of liver damage can be autoimmune, vascular, congenital, metabolic, tumor-induced, viral, and nutritional. Autoimmune liver diseases are the fourth most common indication for liver transplantation worldwide. These include autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, and overlap syndrome (a combination of autoimmune and cholestatic liver diseases). Indications for transplantation are severe liver failure (increased MELD score); irreversible complications of liver cirrhosis, such as ascites, portal hypertension, and hepatic encephalopathy; resistance to immunosuppressive therapy; and severe cholestasis. The patient’s immune profile requires carefully choosing the immunosuppression methods after surgery to reduce the recurrence risk of the autoimmune process. Recurrence of the disease in the transplanted liver is possible, but less pronounced with proper treatment. Conclusions. Liver transplantation in patients with autoimmune liver diseases often improves the quality of life and prolongs it, but requires constant monitoring and support from a hepatologist and a transplantologist.
Introduction. Weight loss in obesity is the main tactic for patient management. However, according to statistics, weight fluctuations occur in 80% of people. This rebound phenomenon can be caused by various factors, but recently there has been an increasing number of studies on the relationship between epigenetic changes and weight fluctuations. Aim. To analyze scientific literature on the influence of epigenetic factors on the development of Yo-Yo syndrome. Materials and Methods. Analysis of research on the relationship between epigenetic factors and the development of Yo-Yo syndrome. Sources: PubMed, ResearchGate, eLibrary, and CyberLeninka. Results and Discussion. One of the key genes is POMC that regulates appetite through producing alpha-melanocyte-stimulating hormone. The methylation level of its promoter, especially in the ventromedial hypothalamus (VMH), correlates with body mass index and ability to maintain weight loss. Low methylation at positions +136 bp and +138 bp is associated with successful weight loss, while hypomethylation of the NPY promoter increases the risk of weight regain. The ghrelin (stimulates hunger) and leptin (suppresses appetite) hormones regulate energy balance through interaction with POMC and NPY neurons. Obesity often leads to leptin resistance, while epigenetic changes, particularly the leptin gene promoter modifications, such as methylation and acetylation, reduce its expression, promoting weight regain. In adipogenesis, transcription factor PPARγ plays a central role regulated epigenetically via histone modifications, chromatin dynamics, and non-coding RNA action. Protein PRDM16 suppresses myogenesis (through hypermethylation of MyoD and myogenin), directing cells towards adipogenesis. Patients with obesity also exhibit the TNFα promoter hypomethylation, enhancing their inflammatory response. After bariatric surgery, gene methylation (PPARGC1A, IL1B, IL6, TNF) temporarily normalizes but returns to baseline levels after 12 months, particularly in PDK4 promoters and pro-inflammatory genes. Studies have found a link between DNA methylation profile and anthropometric measures: Overweight individuals show the reduced methylation of MRTFA, PLEKHO1, and TNFAIP8L2, which activate these genes. Conclusion. Despite adherence to all dietary rules, such cyclical weight behavior may be genetically justified, thus creating a problem maintaining normal body mass. Understanding these mechanisms opens opportunities for developing biomarkers of recurrence risk and personalized prevention and treatment strategies, including prenatal period.
Introduction. Herpesvirus infections remain a serious global health problem due to their ubiquity and ability to cause a wide range of pathologies, from labial herpes through cancer. Eight types of human herpesviruses have a unique ability to latency and reactivation, which significantly complicates controlling them, despite advances in diagnostics and therapy. Aim. To comprehensively analyze contemporary epidemiological data on herpesvirus infections, assess their clinical manifestations and socio-economic burden, and arrange the key issues hindering the development of effective epidemiological control strategies. Materials and Methods. The study was based on a comprehensive analysis of the scientific literature selected from PubMed, Scopus, and Web of Science over the past 15 years. Priority was given to large-scale epidemiological studies, relevant clinical guidelines, and meta-analyses. Results and Discussion. Herpesvirus infections demonstrate global distribution with high seroprevalence (herpes simplex virus type 1 was detected in 67-98% of the individuals examined, while Epstein-Barr virus and cytomegalovirus were found in 90-98% of them). Regional differences are marked for herpes simplex virus type 2 (15–80%) and human herpes virus type 8 (2–30%). The key problem is the ability to reactivate during immunosuppression (the risk increases by 2.1–3.8 times for herpes simplex virus when taking glucocorticoids and up to 68–72% for cytomegalovirus during cytostatic therapy). Herpesvirus infections are associated with oncopathology, neonatal infections, and decreased quality of life. Conclusions. Main difficulties in controlling are the lack of effective vaccines (except for that aimed at preventing from chickenpox virus), ineffective therapy for latent forms, and imperfect diagnostics. Promising approaches include the development of new treatment strategies, improved diagnostics, and international cooperation in the creation of vaccines and drugs
Introduction. Low frequency of obstructive coronary artery disease (OCAD) detection during invasive coronary angiography in patients with stable ischemic heart disease (30–58 %) indicates the need to improve preoperative risk stratification methods using available hematological parameters. Aim. To analyze the predictive potential of hematological parameters for developing prognostic models of obstructive coronary artery disease in patients with stable ischemic heart disease. Materials and methods. A single-center retrospective cohort study was conducted in 1,005 patients (687 men and 318 women) with stable ischemic heart disease, median age 65.2 [60;72] years, who have had invasive coronary angiography. We analyzed 53 demographic, clinical and laboratory parameters, including hematological indices of inflammatory response (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, and neutrophil-to-eosinophil ratio), metabolic indices (atherogenic index of plasma, triglyceride-glucose index, etc.), and hemostasis parameters. Mathematical statistics methods, such as Mann-Whitney test, chi-square test, Fisher’s exact test, and univariate logistic regression, and machine learning methods, such as multivariate logistic regression, were used to develop prognostic models. The study endpoint was represented by the hemodynamically significant (>50%) narrowing of the epicardial coronary artery lumen. Results and Discussion. Obstructive coronary artery disease was detected in 774 (77%) patients, and non-obstructive lesions in 231 (23%) patients. Statistically significant differences between groups were identified for 17 parameters, among which the following demonstrated the greatest predictive potential: Neutrophil-to-high-density-lipoprotein-cholesterol ratio >2.38 (odds ratio = 3.2), eosinophils 0.85–2.5% (odds ratio = 2.8), fibrinogen-to-international-normalized-ratio >3.63 (odds ratio = 2.44), and neutrophil-to-eosinophil ratio <74.4 (odds ratio = 2.42). A prognostic model including 8 categorical features (being a male aged 40–67 years, eosinophils 0.85–2.5%, neutrophils >53%, white blood cells >6.23×10 9 /L, fibrinogen >3.52 g/L, high-density lipoprotein cholesterol <1.33 mmol/L, and prothrombin time <13.1 s) demonstrated high predictive accuracy (area under the curve = 0.778, sensitivity = 0.721, specificity = 0.728). Conclusions. Prognostic models based on a combination of hematological parameters allow for the acceptable risk stratification of obstructive coronary artery disease in patients with stable ischemic heart disease. Using them may help optimize patient selection for elective coronary angiography and reduce the number of undue invasive procedures.
Introduction. The problem of eliminating tuberculosis infection remains highly relevant worldwide. Despite significant progress in tuberculosis chemotherapy at the present stage, surgical treatment continues to be an integral part of the complex therapy for this disease. Its significance is particularly high in case of destructive forms of tuberculosis, drug-resistant mycobacteria, and/or pronounced residual changes in the lungs. Aim . To demonstrate the potential of surgical treatment in a patient with a complicated course of chronic tuberculosis. Materials and Methods. A case of successful complex treatment is analyzed and described, involving a multimorbid female patient with a long tuberculosis history, following complicated surgical interventions for pulmonary tuberculosis with pre-extensively drug- resistant pathogens, in combination with HIV infection, chronic viral hepatitis C, alcohol dependence syndrome, and low treatment adherence. The patient underwent completion pneumonectomy with simultaneous thoracomyoplasty, which was performed without any complications. Results and Discussion. The presented clinical observation demonstrates the surgery capabilities in the most challenging cohort of patients. Modern approaches to surgical treatment can significantly improve the effectiveness of complex therapy in patients with chronic forms of pulmonary tuberculosis and high comorbidity. Conclusions. Patients with fibro-cavernous pulmonary tuberculosis represent a challenging population for achieving positive treatment outcomes. Surgical intervention for pulmonary tuberculosis remains a relevant and effective treatment method, especially in cases of extensively multidrug-resistant tuberculosis, as well as when conservative therapy is ineffective.
Introduction. New-onset atrial fibrillation in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention worsens short-term outcomes of the disease. Currently, no universally accepted tools exist for assessing the risk of this complication. Aim. To develop predictive models for new-onset atrial fibrillation in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention based on pre- and intraprocedural predictors. Materials and Methods. This single-center prospective study included 796 patients with ST-segment elevation myocardial infarction, who were divided into two groups: 68 (8.5%) patients with new-onset atrial fibrillation after percutaneous coronary intervention and 728 (91.5%) patients without arrhythmia. The feature selection algorithm involved statistical analysis, data categorization, predictive model development using CatBoost and multivariate logistic regression, and assessment of predictor importance via Shapley Additive explanations. Efficacy of percutaneous coronary intervention was assessed using the Thrombolysis in Myocardial Infarction (TIMI) score. Results and Discussion . Predictive models for new-onset atrial fibrillation after percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction were developed based on a multistep analysis of pre- and intraprocedural variables. The model with the best performance metrics (AUC = 0.808) included 12 categorical predictors. The most significant and comparable impact on the NOAF development was observed for TIMI < 3 and Killip class > II. Substantial contributions were also noted for blood urea > 8.9 mmol/L, fibrinogen > 5.54 g/L, and chronic heart failure (NYHA class II–III). Less pronounced associations were observed for age > 66 years, monocyte-to-lymphocyte ratio ≥ 0.52, lactate>1.7 mmol/L, neutrophil-to-eosinophil ratio ≥ 48, and systolic blood pressure < 131.5 mmHg. The weakest associations were found for Cl⁻ < 106.5 mmol/L and total cholesterol < 5.4 mmol/L. Conclusions. A multifactorial predictive model for new-onset atrial fibrillation in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention, incorporating pre- and intraprocedural categorical predictors, demonstrated high accuracy and may serve as a useful tool for predicting the risks for this complication.
ntroduction. Currently, the problem of diagnosing health disorders in children during their adaptation to the microsocial conditions of educational institutions (preschool and general education organizations) has evolved into a fundamental multidisciplinary field. It is at the intersection of clinical pediatrics, developmental physiology, child and adolescent hygiene, and educational psychology. Aim . To determine the age-specific clinical manifestations of adaptation syndrome and develop diagnostic criteria for adaptation disorders in children upon their admission to cooperative education institutions. Material and Methods. The study involved 299 children divided into three groups: 109 infants and toddlers (aged 7 months to 3 years), 85 preschool children (aged 4–7 years), and 105 primary school students (aged 7 years). The children were examined prior to their being admitted, throughout their entire adaptation period, and one year after its completion. The following health indicators were analyzed: Physical development; neuropsychological development (using the Rostock test for infants/toddlers, the L.A. Wenger and V.V. Kholmovskaya method for preschoolers, and an adapted Wechsler Intelligence Scale for first graders); morbidity rates based on medical consultations and individual analyses; neuropsychiatric health status based on pediatric psychiatric consultations and parental surveys; and a comprehensive health assessment. Results and Discussion. First graders’ school adaptation period was accompanied by more significant changes in neuropsychiatric health compared to the younger age groups. Neurotic reactions were characterized by polymorphic clinical symptoms and were recorded in 74 of 105 first graders (70.4 %). Notably, no single form of disorder was dominant. Asthenic manifestations were diagnosed most frequently (53.3%). Hyperdynamic syndrome was observed in 41 students (39%), characterized by motor restlessness, fidgeting, and episodic aggressiveness. Conclusions. We were the first in the pediatric practice of Central Asia to determine the age-specific features of the adaptation syndrome patterns in relation to children’s health status through a multidisciplinary medical and pedagogical approach. The study identified the predominant forms of adaptation disorders for various age periods and established clinical criteria for diagnosing them in children entering new social environments.
ntroduction. Pelvic organ prolapse is a common manifestation of pelvic floor dysfunction in women, associated with anatomical displacement of pelvic organs. Aim. To evaluate the effectiveness of conservative treatment of pelvic organ prolapse after spontaneous vaginal delivery using the Elise 2 vaginal electrical stimulator (TensCare). Materials and Methods. The study included 200 women aged 18–35 years, examined 5 months after delivery. The study group (n=100) received electrical stimulation therapy, while the control group (n=100) was observed. The groups were comparable in terms of age, anthropometric parameters, and comorbidities (p>0.05). The treatment lasted 6 months. Effectiveness was assessed using POP-Q, perineometry, and the PFDI-20 questionnaire. The data were processed statistically using the licensed software package Statistica 14. Differences were considered statistically significant at p<0.05. Results and Discussion. After 3 months, pelvic floor muscle strength increased by 18–22% (p<0.05), while stress urinary incontinence decreased by 40% and foreign body sensation by 55%. After 6 months, perineometry values were higher in the study group (50.39±1.62 and 54.43±1.5 mmHg) compared to controls (43.47±1.6 and 49.86±1.72 mmHg; p<0.05). PFDI-20 scores decreased more than twofold. A negative correlation between muscle strength and symptom severity was identified (r = -0.62; p<0.05). Conclusions. The use of the Elise 2 vaginal electrical stimulator improves pelvic floor function, reduces prolapse symptoms, and enhances quality of life, confirming its effectiveness in the postpartum period.
Introduction. Charcot neuroarthropathy is a severe complication of diabetes mellitus. Although the clinical picture of Charcot neuroarthropathy is well-defined, the underlying immunological mechanisms have not been fully elucidated, thereby constraining the efficacy of therapeutic approaches, particularly those aimed at osteoclast inhibition. An important research trend is the studies of abnormal neutrophil activation and their ability to form extracellular traps. Aim. To study the features of forming neutrophil extracellular traps by leukocytes isolated from venous blood in patients with type 1 and type 2 diabetes mellitus complicated by diabetic foot syndrome without and Charcot neuroarthropathy. Materials and Methods. Three groups were examined: “Control” (healthy volunteers, n=12), “Patients with diabetic foot syndrome” (n=7), “Charcot foot” (n=8). Cells were isolated by gradient centrifugation on Ficoll-Verografin. Cell samples from the mononuclear and granulocyte fractions were examined using light microscopy (Romanowsky-Giemsa stain) and luminescence microscopy (neutrophil extracellular traps were stained with propidium iodide). Spontaneous and induced NETosis was assessed ex vivo. Results and Discussion. In the mononuclear fraction without stimulation, cloud-shaped and filamentous extracellular traps that had been absent in the “Control” group, were detected in both groups of patients, indicating spontaneous NETosis. Number of cloud-shaped neutrophil extracellular traps was higher in the “Charcot foot” group (p=0.0175), while filamentous traps were significantly more frequent in both patient groups compared to the control (p=0.0379 and p=0.0006, respectively), with a predominance of filamentous forms in the “Charcot foot” group. In the granulocyte fraction, an increase in filamentous traps was noted in the “Patients with diabetic foot syndrome” group (p=0.0141). The “Charcot foot” group showed pronounced interindividual variability. Induced NETosis in the “Charcot foot” group in the granulocyte fraction was characterized by a predominance of filamentous neutrophil extracellular traps (p=0.0093). After exposure to an antigenic stimulator (probiotic), both patient groups showed a low ability of normal-density neutrophils to form extracellular traps, indicating a weakening of their antimicrobial activity implemented via this mechanism. Conclusions. Neutrophils of normal and low density were identified in the blood of patients with diabetes mellitus. In patients with diabetic foot syndrome and Charcot neuroarthropathy, low-density neutrophils and, possibly, monocytes are prone to spontaneously forming extracellular traps, which is more pronounced in the “Charcot foot” group. Induced NETosis was characterized by predominantly forming filamentous extracellular traps and especially intense in the “Charcot foot” group. Normal-density neutrophils in the patient groups are characterized by a reduced ability for induced NETosis in response to antigenic stimulation with a probiotic.
Introduction. Cancer-related systemic inflammatory response is one of possible tumor progression indicators. Systemic inflammation markers in serum are reported in the scientific literature, which may be useful for predicting survival or assessing the risk of recurrence, such as neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR), systemic inflammation index (SII), C-reactive protein (CRP) concentration, systemic inflammatory response index (SIRI), etc. Developing an optimal biomarker useful for predicting relapse or poor prognosis is clinically important for identifying patients who may benefit from the combination and comprehensive treatment, including chemotherapy, chemoradiation therapy, and extended surgery. The point of these markers is their predictive role with regard to unfavorable prognosis in both oncologic diseases and other diseases, since in this case they will also depend on the patient’s comorbid background, and predict the patient’s risk of death considering their comorbid pathology. Aim. To evaluate the correlation between the colorectal cancer patients’ overall survival indices and inflammatory markers. Materials and Methods. Data of 232 patients with histologically verified colorectal cancer were studied retrospectively according to the materials of the cancer register of the oncological dispensary of the Ministry of Health of the Republic of Tatarstan. Sampling was performed for 2017, for further study of 5- and 10-year survival of these patients. Inclusion criteria for the study were as follows: Patients with colorectal adenocarcinoma T 1-4, N any, M any. Exclusion criteria were the presence of acute inflammatory processes, such as abscess or phlegmon, active bleeding within the last 6 months, and congenital/acquired immunodeficiencies (including HIV/AIDS). Systemic inflammatory response indices were collected, counted, and evaluated. Further, the data obtained were intercompared. The research included collecting, computing, and assessing the patients’ systemic inflammatory response indices. The data obtained were analyzed and intercompared to identify the statistically significant relationships with overall survival rates. Statistical analysis was performed using the MedCalc v.20.104 software. Results and Discussion. The present study showed that changes in hematologic parameters reflecting the severity of systemic immune inflammation and systemic inflammatory response in patients with colorectal cancer correlate with their disease prognosis. Conclusions. Despite the small number of patients, our study showed that the increased values of SII and NLR are potential predictors of disease outcome in patients with colorectal cancer.
