Vrach

Bleeding is the main cause of death in severe trauma. Time and accurate diagnosis are crucial factors in the treatment of continuing bleeding. A possible solution may be a combination of traditional traumatological operations with interventional radiology methods in hybrid operating rooms. The purpose of this review is to evaluate, according to the reports, indications for the use of hybrid operating rooms in severe trauma, organizational issues, equipment, the composition of operating teams, their training, radiation safety issues and the results of using hybrid operating rooms.

The technology of smart dressings – modern portable devices for healing wound defects, most successfully combines the therapeutic electrical stimulation mode and physiological monitoring of the wound environment for the most effective control over the treatment processes. This review presents the latest data on the operating principles and device of a smart dressing that can monitor various biochemical and physiological parameters of the wound environment (temperature, impedance, oxygen, acidity of the environment (pH), urea, lactate) in real time, as well as updates in the operation of devices and their clinical application. With the possibility of non-invasive diagnosis and treatment of wounds, smart dressings can play an important role in the care and healing of wound defects.

Objective. To evaluate the concentration of circulating microRNA-29a in patients with various clinical forms of hypertrophic cardiomyopathy (HCM) and compare it with the levels observed in healthy volunteers.

Materials and methods. The study included 84 participants: 42 patients with a confirmed diagnosis of HCM and 42 healthy volunteers (control group). All subjects underwent comprehensive clinical and instrumental examination, including transthoracic echocardiography and 24-hour Holter ECG monitoring. The concentration of microRNA-29a in plasma was measured using quantitative real-time PCR with the TaqMan system.

Results. A statistically significant reduction in circulating microRNA-29a levels was found in patients with HCM compared to the control group, regardless of the clinical variant of the disease. These findings support the consideration of microRNA-29a as a potential universal biomarker reflecting the activity of fibrotic processes and the degree of myocardial remodeling in HCM. The results emphasize the importance of epigenetic mechanisms in the pathogenesis of HCM and highlight their potential utility in diagnosis and risk stratification.

Objective. To develop a method for quantitative determination of carcinoembryonic antigen (CEA) content in endophytic cancer tissues and colon mucosa and to assess the possibility of practical application of the obtained data.

Materials and methods. The study material included biopsies of endophytic cancer tumors and mucosa taken during colonoscopy from 16 patients with colorectal cancer and 18 control group patients aged 36 to 72 years. Quantitative determination of CEA content was performed in biopsy homogenates using an modified method using immunochemiluminescent analysis on an automatic analyzer.

Results. The data obtained indicate a significantly higher CEA content in cancer tumor tissues compared to the surrounding mucous membrane and can serve as a basis for laboratory differential diagnostics of colorectal carcinomas with rapid and slow growth rates, including interval cancers.

Objective. To determine the associations of self-assessment of health with the level of education among men working on expeditionary shifts in the oil and gas production complex of the Arctic region of Russia.

Material and methods. The object of the study was a “random” representative sample of 750 male workers aged 25–54 years engaged in mobile labor in the Arctic latitudes of the Russian Federation; the response to the study was 82.4%. The level of education was determined by the following parameters: higher/secondary education, work experience as an expeditionary watch: ≤3 years; 4–9 years; ≥10 years.

Results. Among persons engaged in expeditionary rotational work, the average level of education was determined predominantly, with a predominance of the indicator in the fourth and fifth decades of life. With work experience in expeditionary watch conditions ranging from four to nine years and a higher level of education relative to its average level, the lowest self-assessment of health was established.

Conclusion. Thus, the results of determining the associations of the level of education with the parameters of self-assessment of health among workers of the oil and gas production complex, depending on the length of service in expeditionary rotations, must be used as a significant part of a comprehensive preventive program at industrial enterprises of the Arctic region.

Objective. To study the efficacy and tolerability of Urinalgin F in the treatment of acute cystitis in women with diabetes, as well as to evaluate the effect and tolerability of the dietary supplement Urinal Active in maintaining the function of the urinary system.

Material and methods. A scientific work was conducted at three clinics in the Perm Krai on the use of Urinalgin F in combination with the antibiotic cefixime for the treatment of acute cystitis in 74 women aged 18 to 89 years with diabetes. The ACSS International Cystitis Scale, a visual analog scale (VAS) for pain, and laboratory and bacteriological tests were used. The main group consisted of 37 women who orally received Urinalgin F at a dose of 200 mg 3 times a day for 2 days and cefixime at 400 mg once a day for 7 days. The comparison group consisted of 37 women who orally received cefixime at the same dose for 7 days and drotaverine hydrochloride at 80 mg 3 times a day for 2 days. To further support normal urinary function, Urinal Active was administered to 37 women in the main group in monthly courses of 14 days for 6 months. The second group received no additional supplements.

Results. In the main group, a pronounced analgesic and antidysuric effect of the drug Urinalgin F was established, confirmed by the analysis of the ACSS and VAS scales. The clinical efficacy (recovery) of combination therapy with Urinalgin F and cefixime was 94.6%, bacteriological efficacy was 91.4%, and the period of temporary disability was reduced by 30.8%. In the comparison group, clinical (89.2%) and bacteriological (84.9%) efficacy were significantly lower. Urinalgin F had one (2.7%) side effect of nausea. During a follow-up examination after 6 months, it was found that Urinal Active contributed to a significant improvement in bladder health: 94.6% of those examined had a normal urine test, and 97.3% had no bacteriuria. Compared with the control group, which did not use additional means, in the group using the Urinal Active complex, the number of patients with bacteriuria decreased by 8 times, and the number of relapses of acute cystitis decreased by 9 times (2.7% versus 24.3%). The overall treatment duration was reduced by 59.1%. A favorable tolerability profile of the Urinal Active complex was noted (no adverse events were reported).

Conclusion. Combination therapy of acute cystitis in women suffering from diabetes mellitus with the selective uroanalgesic drug Urinalgin F and the antibiotic cefixime has high clinical and bacteriological efficacy. Urinalgin F is well tolerated by patients with diabetes, significantly eliminates pain and dysuric symptoms of cystitis, and helps to reduce the duration of treatment. Compared with the control group, which did not use additional means, in the group using the Urinal Active complex, normalization of the urinary system condition can be observed, an 8-fold decrease in the number of women with bacteriuria, and a 9-fold decrease in the number of cystitis relapses.

To evaluate the efficacy of peptide hydrolysates of animal and fish origin in reducing the severity of symptoms in patients with chronic diseases of the digestive system. Patients with chronic gastritis, chronic pancreatitis, gastroesophageal reflux disease, chronic constipation, intestinal malabsorption, multiple intestinal polyposis participated in the study. The prevalence of symptoms of the described diseases among participants was assessed before treatment and during one year of peptide hydrolysate supplementation. By the end of the course of monotherapy with peptide hydrolysates, the prevalence of all analysed symptoms of chronic digestive diseases was significantly lower compared to the pre-test results. The clinical effect in the majority of patients was achieved within the first 3–6 months of treatment.

Objective. To evaluate changes in markers of coagulological blood analysis in relation to markers of systemic inflammation in patients with sarcoidosis after COVID-19 during treatment.

Material and methods. The study included 20 patients who were divided into 2 groups: main group (n=10) – patients with newly diagnosed intracoracic lymph nodes sarcoidosis and lung sarcoidosis in the active phase who suffered COVID-19; control group (n=10) – patients with newly diagnosed intracoracic lymph nodes sarcoidosis and lung sarcoidosis in the active phase without COVID-19 in the anamnesis. Biochemical studies were carried out at two control points: at the admission of patients to the clinic and in dynamics after 2 weeks of treatment. The following parameters were evaluated: activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen, thrombin time (TT), antithrombin III (ATIII), D-dimer, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).

Results. Analysis of the study results showed that before the start of treatment in the mane group, a decrease in APTT levels was significantly more common compared to the control group (p = 0,00001), an increase in fibrinogen levels (p = 0,0006) and D-dimer (p = 0,00003). After 2 weeks of treatment, the number of patients in the mane group with a hypercoagulation shift remained the same, and there were no such patients in the control group. Analysis of the CRP and ESR markers showed that before the start of treatment, patients with systemic inflammation were found in both groups. After 2 weeks of treatment in both groups, the number of patients with both increased CRP, and with increased ESR.

Conclusion. Before the start of treatment, patients with newly diagnosed intracoracic lymph nodes sarcoidosis and lung sarcoidosis in the active phase with a history of COVID-19 were significantly more likely to have a hypercoagulation shift, which was associated with the presence of pronounced systemic inflammation in these patients. After 2 weeks of treatment, the number of patients with a hypercoagulable shift remained at the same level, despite a decrease in the incidence of patients with elevated values of systemic inflammation markers, which indicated that in addition to inflammatory reactions, changes in the vascular endothelium probably played a role in the development of hypercoagulable disorders.

Objective. To investigate the structure of indications for bronchoscopy in patients at a coronavirus hospital depending on the specific epidemiological situation during the COVID-19 pandemic.

Materials and methods. Indications for 1050 (100%) bronchoscopies in 668 patients at a coronavirus hospital were analyzed. The procedures were categorized as primary or repeat bronchoscopies and were performed in both the endoscopy department and the intensive care unit. The comparison of indications was made during conditionally defined periods of hospital functioning: the first period was associated with the dominance of the British, Indian, and African strains of the coronavirus, while the second period was marked by the dominance of the Omicron strain.

Results. During the first period, indications related to hemoptysis or higher-grade pulmonary bleeding prevailed with statistical significance. In the second period, indications for bronchoscopy due to severe obstruction of the lower respiratory tract by bronchial secretions showed a statistically significant predominance.

Conclusion. The structure of indications for bronchoscopy dependents on the specific epidemiological situation. During the dominance of early strains of the coronavirus, hemoptysis and higher-grade pulmonary bleeding were the leading indications. In contrast during the dominance of Omicron, the primary indication was increasing obstruction of the lower respiratory tract due to bronchial secretions.

Purpose. The structure of concomitant diseases in patients with pulmonary tuberculosis with tobacco dependence.

Materials and methods. A retrospective cohort study was conducted on the basis of the Department of Phthisiology. The study included 188 patients with pulmonary tuberculosis who were divided into two groups depending on their smoking status: 1st (n=83) – smoking patients; 2nd (n=105) – non-smoking patients.

Results. It was found that concomitant pathology was significantly more common among smokers compared with non-smokers (p <0.001). At the same time, the presence of two or more concomitant diseases is also significantly more common in smoking patients (p = 0.097). In the structure of concomitant diseases, attention is drawn to the fact that type 1 and type 2 diabetes mellitus is significantly more common among smokers (p = 0.032), as well as chronic viral hepatitis C (p = 0.032).

Conclusion. The obtained results show that the course and effectiveness of treatment of patients with pulmonary tuberculosis is influenced by a significant factor in the form of tobacco smoking, as well as a wide range of comorbidities among smokers. The study and search for optimal approaches in the treatment of tobacco dependence, as well as the correction of comorbidities, is an extremely relevant and important direction in modern phthisiology.

The article presents a clinical and laboratory algorithm for choosing antibacterial drugs in surgical interventions in the oral cavity. A prospective study was conducted involving 40 patients with surgical pathology of the maxillofacial region. The developed algorithm is based on a comprehensive approach, including stratification of the risk of infectious complications, assessment of the patient's somatic status, rapid microbiological diagnostics and systematic monitoring of treatment effectiveness. The structure of pathogens of infectious complications is presented, among which Streptococcus spp., Staphylococcus aureus and anaerobic microorganisms predominate. Multivariate analysis revealed key risk factors for an unfavorable outcome: diabetes mellitus, age over 60 years, prevalence of inflammation and the presence of microbial associations. The application of the developed algorithm allowed to reduce the postsurgical period by an average of 2.5 days, increase the effectiveness of prevention and treatment of infectious and inflammatory complications, and promote rational use of antibiotics and reduce the risk of antibiotic resistance.

The article provides a comprehensive analysis of modern data on the clinical and pathogenetic features of comorbid forms of localized scleroderma, including a review of literature sources and a description of our own clinical observations. The results obtained expand the understanding of the pathogenesis of autoimmune dermatoses and may contribute to the improvement of diagnostic and therapeutic algorithms for the management of patients with combined pathology.

The skin of the scalp is an anatomical area with a specific structure; melanocytic nevi in this localization tend to show different signs that differ from those of melanocytic nevi in other anatomical areas not only clinically, but also pathomorphologically, often demonstrating morphologically atypical signs without obvious atypical clinical behavior. This article presents a clinical case of a patient with a complex melanocytic nevus of the skin of the scalp and a detailed pathomorphological description of these signs. The description of this clinical case may be useful for dermatovenerologists, trichologists and pathologists to raise awareness about the features of melanocytic nevi of the scalp.

In recent decades, there has been a steady increase in cervical pathologies, among which inflammatory processes, precancerous and cancerous diseases, HPV infections, and cervical ectopy are of particular relevance. All of these pathologies have a negative impact on the course and outcome of pregnancy. The objective of our study is to investigate the epidemiology of cervical diseases during gestation, focusing on the frequency of specific nosologies. Special attention was paid to cervical ectopy, gravidary polyps, and cervical erosion.

The article describes a clinical case of acute myocardial infarction (AMI) with ST segment elevation in a 60-year-old man with metabolic syndrome (MS). The patient has a long-term history of hypertension, impaired glucose tolerance and dyslipidemia, while the patient adhered to all recommended therapy. However, despite this, he periodically had chest pains, shortness of breath, and general weakness. In the spring of 2024, the cardio-pain syndrome lasted for 3 days, AMI developed, and a feeling of fear of death appeared. The patient's condition is on the background of thrombolytic therapy and direct stenting of the right coronary artery with positive dynamics. Subsequently, Cardiotone (a natural cardioprotector that strengthens the heart muscle by improving its oxygen supply, relieves inflammatory processes in the myocardium, and has antihypertensive, anti-ischemic, and cardiometabolic effects) was added to the previously recommended therapy. It is recommended for disorders of the cardiovascular system, as well as for increased physical exertion.

This clinical case demonstrates that the course of cardiovascular diseases associated with MS can very often and quickly become malignant, and even against the background of adequate therapy. After taking Cardiotone for more than a year, the studied patient has been feeling well in the post-infarction period, notes the absence of cardio-pain syndrome, normalization of blood pressure levels, and improvement in the quality of life in general. During the control routine coronary catheterization, the planned stenting of the obtuse edge branch was not required.