Vol 33, No 1 (2022)
Articles
External genital endometriosis: opportunities for early diagnosis and prevention of recurrence
Abstract
Selected issues of morbidity in the working population in the Central Federal District in 2005-2020
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Pathogenesis of neonatal respiratory distress syndrome from the standpoint of the features of the embryogenesis of the respiratory system
Abstract
The paper is devoted to the problems of the pathogenesis of neonatal respiratory distress syndrome (RDS), by taking into account the peculiarities of embryonic development of the lungs, the production and maturation of surfactant, and the development of respiratory organs. It elucidates the characteristics and clinical role of surfactant in perinatal lung adaptation and the development of RDS in preterm infants. The authors discuss the epidemiological aspects of preterm labor, the features of regulation of respiratory organs and the surfactant system, anatomical and morphofunctional immaturity of the lungs, fetal breathing movements, and the mechanism of the first breath. The paper considers the concept of aerogematic histion, fetal lung function, and criteria for neonatal assessment of the clinical presentation of respiratory failure in premature babies in the early neonatal period.
The possibilities of using a biologically active supplement SELENBIO for women in cases of reproductive health disorders
Abstract
The review of information on the effect of the trace element selenium (Se) on reproductive health, pregnancy and lactation was carried out. The article presents research data showing that an increased need for Se is noted during pregnancy and lactation, and selenium deficiency leads to disorders of the reproductive system, complications of pregnancy and childbirth, and the development of disorders in the fetus. It has been shown that the use of SELENBIO for women dietary supplement containing selenium, zinc, vitamins C and E can be a way to prevent Se deficiency.
On the efficacy of parenteral chondroitin sulfate in patients with osteoarthritis in the presence of grade 1 functional joint failure
Abstract
It is necessary to reconsider the use of drugs affecting the pathobiochemical pathways in the development of cartilaginous tissue structural changes in functional joint failure (FJF) in the presence of osteoarthritis (OA). Objective. To evaluate the efficacy of the parenteral formulation of the pharmaceutically active substance chondroitin sulfate (CS; Chondroguard®, CS-Bioactive© Bioiberica S.A.U., Spain, manufactured by the ZAO «FarmFirma “Sotex», Russia) in patients with Stage II knee OA (KOA) and grade 1 FJF. Subjects and methods. A 50-day open-label, prospective, controlled, randomized trial was conducted according to inclusion/exclusion criteria. The trial enrolled 82 patients with Stage II KOA, grade 1 FJF, who were divided into two groups: 1) 42 patients received CS (Chondroguard®, 100 mg/ml) intramuscularly every other day; the first three 1-ml injections; and if well tolerated, the fourth and next 2-ml injections (a 50-day treatment cycle included 25 injections); 2) 40 patients took celecoxib at a dose of 200 mg/day, which can be reduced to 100 mg/day and discontinued. On days 0 and 50, the investigators assessed pain intensity using a visual analogue scale (VAS), Lequesne’s functional indices, WOMAC, and joint ultrasound data and the safety of therapy using the WHO and Naranjo scales. The data were statistically processed applying the Statistica 10.0 software (StatSoft, Inc., USA). Results. Chondroguard® therapy was well tolerated by patients and was accompanied by a significant improvement in pain intensity scores according to VAS (U test=7.79; p<0.0001), a decrease in the severity of OA according to Lequesne’s indices (U test=7.79; p=< 0.0001), and WOMAC (U test=7.12; p=<0.0001). There was a decline in the number of combined signs of synovitis and tendonitis in Group 1 (Chondroguard®) as compared with that in Group 2 (celecoxib). A marked improvement in the Lequesne subscales («Pain and discomfort», «Walking distance», «Daily activity») and WOMAC was also recorded in patients receiving Chondroguard®. Conclusion. The use of Chondroguard® is effective and safe in patients with Stage II KOA and grade 1 FJF, who require outpatient care.
A clinical case of inflammatory cardiomyopathy due to experienced subacute viral myocarditis associated with the new coronavirus infection COVID-19 of occupational genesis
Abstract
Health care workers are increased risk group of SARS-CoV-2 infection when providing medical care. The novel coronavirus infection (NCI) in healthcare workers can be considered an occupational disease if the infection occurs when they fulfil their professional duties. Damage to the cardiovascular system is one of the most important complications of NCI. The paper describes a clinical case of a serious NCI complication that develops in the presence of chronic autoimmune disease - severe myocarditis with pulmonary embolism, which leads to inflammatory cardiomyopathy with congestive heart failure in a healthcare worker. The paper presents the principles and results of a medical examination made to establish a causal relationship between the disease and professional activities.
Clinical rationale for the use of autologous platelet-rich plasma during cesarean section
Abstract
The use of autologous platelet-rich plasma (aPRP) is one of the modern methods to model tissue regeneration, which promotes acceleration of scar formation, activation of collagenization and angiogenesis, and maturation of connective tissue. Objective. To evaluate the therapeutic efficiency of intraoperative aPRP use for intensifying the mechanism of reparative wound regeneration after cesarean section (CS). Subjects and methods. Fifty pregnant women who had undergone surgical delivery participated in the investigation. During the latter, the patients were randomized into 2 groups according to the type of surgery: 1) standard CS; 2) CS using aPRP. Clinical, laboratory, and instrumental studies were applied. Results. The incorporation of aPRP during CS has been shown to be an easy-to-use method that does not increase the duration of surgical therapy and significantly reduces blood loss by 26.3% (p>0.05). The use of aPRP in the early stages of CS is accompanied by a decrease in peripheral vascular resistance and by an improvement in blood flow, which leads to the stimulation of wound regenerative processes, to the intensification of angiogenesis, to the acceleration of tissue remodeling, to a reduction in the phase of wound healing, and, as a result, to a lower incidence of pyoseptic complications. Conclusion. aPRP can be used during CS to reduce the risk of pyoseptic complications and to create an optimal and adequate uterine scar.
Telemonitoring of the health status in pregnant women in a risk group of preeclampsia
Abstract
The practical application of telemedicine information technologies has allowed the obstetric facilities of the Sverdlovsk Region to implement health status telemonitoring in patients with hypertension and those in a risk group of preeclampsia during pregnancy management.
Respiratory strategies affecting the severity of neonatal transient tachypnea
Abstract
Introduction: Transient tachypnea of the newborn (TNT) is a parenchymal lung disease characterized by pulmonary edema and is a common cause of respiratory distress in the first hours of life. Diagnosis and treatment of TTN consists in timely detection of respiratory disorders, determination of their severity and selection of the appropriate method of respiratory strategy, which allows avoiding hospitalization in the neonatal intensive care unit (NICU) and severe complications. Objective of the study: to analyze the respiratory strategy of patients with TTN, which determines the severity of the course of the disease, and to identify among patients a risk group for the formation of the most severe variant of the course of the disease. Methods: Retrospective analysis of full-term newborns of the Yekaterinburg Clinical Perinatal Center in 2020 with a diagnosis of TTN (n=201). A comparative analysis of 3 groups of patients, allocated in accordance with the routing from the delivery room, was carried out. Results: Our study made it possible to highlight the group of patients admitted to the ICU not from the delivery room, but from the neonatal department. These infants showed the most severe course of TTN and the longest hospital stay among all the studied groups. Also, significant differences between the groups were found in the assessment of the severity of respiratory failure and the tactics of respiratory strategy in the delivery room and the neonatal department. Conclusions: The results of the study proved the following: 1. full-term patients with TTN hospitalized from the neonatal department in the ICU show the most severe course of the disease; 2. An assessment of respiratory failure of 3 points on the Downs scale at the stage of the delivery room is a sign of an unfavorable course of TTN and a high probability of hospitalization in the ICU; 3. The severity of the condition of patients with TTN is directly affected by the absence of CPAP in the delivery room and the duration of therapy with high-flow cannulas in the neonatal department.
Characteristics of immune hormonal and trace element homeostasis in overweight male adolescents and its diagnostic value
Abstract
Environmental changes and nutritional quality affect metabolic processes, which is accompanied by metabolic and endocrine diseases, especially in the child population. Objective. To substantiate the diagnostic examination and etiotropic therapy schemes that can reduce the influence of disease-producing factors on metabolism in male adolescents with alimentary obesity in environmental risk areas. Subjects and methods. Forty-five boys were examined: Group 1 consisted of 25 boys who lived in a technologically polluted area; Group 2 included 20 ones who lived in an ecologically clean area of the city. Group 3 comprised 10 healthy schoolchildren who had normal weight and lived in an ecologically clean area (a control group). Anthropometric indices, body mass index (BMI), Tanner stage of puberty, insulin resistance index, and complete blood count were determined. The urinary concentrations of lead (Pb), vanadium (V), chromium (Cr), copper (Cu), zinc (Zn), and selenium (Se) were measured by an atomic absorption method on a Kvant-Z analyzer (OOO «Kortek», Russia). The blood levels of glucose, lipid fractions, and malondialdehyde were estimated. The immune status was established by the level of the main classes of serum immunoglobulins by a radial immunodiffusion technique in gel. Adiponectin, leptin, cortisol, total testosterone, and insulin were detected by enzyme immunoassay on an Alisei Radium analyzer (Italy). The results were processed by statistical variation methods. Results. The most negative immune hormonal changes in the presence of microelementosis were found in boys from the environmental risk group. There was an inversely proportional relationship between adiponectin level and BMI. High leptin levels and lower urinary concentrations of Se, Cr, and Vcorresponded to increased BMI in children with hyperinsulinemic phenomena. No signs of microelementosis were observed in adolescents with slightly higher body weight. Conclusion. The findings suggest that mitosis plays an etiological role in neuroexchange disorders of homeostasis and provide evidence for the modification of a diagnostic examination and etiotropic therapy in male adolescents from environmental risk groups with alimentary obesity.
Osteoporosis in postmenopausal women: sociomedical significance, prevention of fractures with Osteomed and Osteomed Forte
Abstract
The paper presents data from Russian and foreign studies on the sociomedical significance of osteoporosis (OP) as a systemic disease of the skeleton. Women over 50 years of age in Russia are shown to have OP and osteopenia in 34 and 43%, respectively. The pathogenesis of OP is depicted in women in postmenopause. At this time the risk of osteoporotic fractures at different sites is noted to increase. The paper considers various strategies for complex prevention and treatment of OP, including those with Osteomed and Osteomed Forte.
Diagnosis and treatment of familial Mediterranean fever (periodic disease)
Abstract
Familial Mediterranean fever (FMF; periodic disease) is an autosomal recessive disease, the features of which are recurrent inflammatory episodes, abdominal pain, fever, and arthritis. FMF is divided into two phenotypes. The most accurate diagnostic method is molecular genetic testing that includes a single-gene study, utilization of a multigene panel, and more whole- genome testing. The main therapy for the disease includes colchicine; its acute episodes are treated with nonsteroidal anti-inflammatory drugs and infusion therapy. Drugs, such as anakinra, rilonacept, and canakinumab, are used to treat colchicine-resistant FMF patients. The article describes the clinical case of a female patient with FMF.
Langerhans cell histiocytosis of the temporal bones: a clinical case
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease with an incidence of 1 to 9 cases per 1,000,000 population per year. From 75 to 90% of cases of the disease occur in childhood. The etiology of the disease is unknown. Pathogenetically, the disease is characterized by a clonal proliferation of Langerhans cells - the lymphoid dendritic cells originating from the bone marrow have an antigen-presenting function outside the dermis. The temporal bones are affected in 2530% of cases. The disease is more common in males. The peak incidence occurs in the first 3 years of life. The disease can be asymptomatic for a long time or be masked as other common middle ear pathologies (chronic suppurative otitis media, mastoiditis, and otitis externa). The article describes a clinical case of temporal bone LCH. The feature of the clinical case in the recurrent course of the disease is that it is masked as acute mastoiditis.
Significance of indicators of intestinal permeability, the state of the microbiota in the development of gastroenterological manifestations in the treatment of patients with a new coronavirus infection (COVID-19)
Abstract
The effectiveness of combating the pandemic of a new coronavirus infection (COVID-19) is based on a detailed analysis of the pathogenetic features of the course of SARS-CoV-2 infection, including an assessment of the state of the microbiota and intestinal permeability during the treatment of COVID-19 patients. Purpose: To study the dynamics of intestinal permeability, qualitative and quantitative composition of microbiota in the treatment of COVID-19 patients. Material and methods. The study was performed in 80 patients with COVID-19, whose average age was 45years, 19 of them had mild and 61 had moderate severity of the disease. The scope of the examination included traditional clinical, clinical and laboratory, biochemical, instrumental and radiation studies, as well as original methods for studying intestinal permeability and microbiota. Rebamipid was used as an element of complex pathogenetic therapy in the treatment of 41 patients (51.3%). Results and conclusions: The clinical, laboratory and radiation semiotics of COVID-19 were studied, the interdependence of manifestations of systemic inflammation, changes in the intestinal microbiome in patients with mild and moderate severity was revealed. The characteristic dynamics of the concentration levels of proinflammatory cytokines, insulin, fecal calprotectin and zonulin, reflecting the peculiarities of changes in intestinal permeability during COVID-19 treatment, has been established. The necessity of correction of intestinal permeability in the treatment of COVID-19 patients has been proved, the effectiveness of rebamipid when used at the inpatient stage of treatment and with further use in the process of outpatient rehabilitation has been confirmed.