Vestnik of the Smolensk State Medical Academy
ISSN (print): 2225-6016, ISSN (online): 3033-5906 Founder: Smolensk State Medical University Editor-in-Chief: Kozlov Roman S., Corresponding Member of the RAS, Doctor of Sc., Full Professor Frequency / Assess: 4 issues per year / Open Included in: Higher Attestation Commission list, RISC
Objective. To evaluate the etiopathogenetic and morphological features of different types of sepsis of viral etiology. Methodology. The conceptual, process, situational, logical and systematic analysis of full-text versions of literary sources devoted to sepsis of viral etiology was used. Results. Sepsis caused by viruses is an existing but constantly underestimated type of sepsis. This sepsis can be caused by various viruses, but more often they are influenza viruses, herpes simplex, enteroviruses, parechoviruses, coronaviruses and dengue virus. Based on the data presented, it can be assumed that the majority of extremely severe forms of viral infections with dysfunction of internal organs are sepsis. It is most likely that sepsis is usually triggered by a single microorganism, but then new pathogens usually join it, both from the outside and by reactivating dormant infections. Therefore, it may be worthwhile initially to consider sepsis, which is already present in the patient, as a kind of disease of mixed infectious etiology. The full range of microorganisms that cause sepsis is extremely difficult to identify and take into account in real clinical practice, especially in dynamics. But it is based on this that the diagnosis and treatment of sepsis should be approached. Perhaps this "polypathogenic" approach will reduce mortality in sepsis. Early diagnosis of sepsis is also very important. Unfortunately, there are still no simple and unambiguous clinical criteria, laboratory signs and morphological changes, that would uniquely identify a patient with sepsis. Conclusions. In sepsis, along with the "direct" fight against infection, it is equally important to restore the normal functioning of the immune system, as well as to stop the "self-destruction" of the body. This can be facilitated by the proposed concept of the "presepsis" stage for early diagnosis of sepsis. It may be worth considering the feasibility of including the "presepsis" stage in the classification of sepsis, significantly detailing its clinical, laboratory and morphological parameters, taking into account their sensitivity and specificity. The essence of this stage is not only that it begins with a syndrome of systemic inflammatory response of the body of infectious origin, but also that such a "response" of the body is steadily progressing, triggering a syndrome of compensatory anti-inflammatory response, usually against the background of the patient's body characteristics, often already having prerequisites for immunosuppression already at the very beginning of sepsis development. Assessment and correction of the patient's immune status in dynamics should play an important role both in the early diagnosis and in the treatment of sepsis, along with other areas. It is likely that understanding these problems, as well as a detailed study of the mechanisms of pathomorphogenesis of viral sepsis, will make it possible to find molecular targets, and then create drugs that directly affect viruses and mechanisms that allow the immune system to destroy them.
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HYPOXIA INDUCIBLE FACTOR-1 AS A POTENTIAL MARKER OF THE SYSTEMIC MECHANISM FOR ADAPTATION OF ACUTE TRAUMATIC DISORDER
Objective. Investigation the possibility and effectiveness of using hypoxia-inducible factor 1 as a biomarker of severe stress-associated disorders and post-traumatic stress disorder.Methods. The study was conducted on male Vistar rats after exposure to lethal threat to life in the “predator-prey” model. The animals were divided into 4 groups, in which the dynamics of the laboratory index was evaluated at different terms after the stressogenic impact. In the first group of animals, the acute stress-associated reaction to a life-threatening stimulus was investigated at 1 day. In the second group on the 3rd day the acute stress-associated reaction to life-threatening stimulus was investigated. In the third group, a delayed stress-associated reaction to a life-threatening stimulus was studied on day 7. The group of control (intact) rats was used as a control.Results. Comparison of the level of HIF1α in the blood, amygdala and cerebral cortex in the “predator - victim” model, 1 day after exposure, after 3 days and after 7 days, using two-factor rank analysis of variance, demonstrated a statistically significant decrease in the level of HIF1α in the blood of rats 3 days after modeling in comparison with the level of HIF1α in the control group. When examining the level of HIF1α in the cortex and amygdala in all groups of animals studied, no statistically significant differences were revealed.Conclusion. Adaptive systemic and neurogenic processes to severe psychotraumatic effects were studied, determining the physiological significance of HIF1α and the dynamics of changes in its concentration over time. Results, the obtained on experimental models open up prospects for further research, including with the participation of a person to develop new therapeutic approaches to the diagnosis and pharmacological correction of severe stress disorders.
EVALUATION OF THE TRANSPORTATION OF KISSPEPTINS THROUGH A BLOOD-BRAIN BARRIER AFTER INTRANASAL ADMINISTRATION
Objective. The aim was to assess efficiency of Kisspeptin -10 during transportation through a GEB after intranasal administration. Methods. The study used 45 outbred mice. The first group of experimental animals was not exposed to any effect - an intact group. In the second, third and fourth group, animals received kisspeptin-10 intranasally in doses of 0.1, 1 and 10 μg, respectively. In the fifth, sixth and seventh group, experimental animals received kisspeptin-10 in doses of 1, 10, 100 μg intra-abdominal in the amount of 0.2 ml, respectively. In the eighth group, animals received a physiological solution of intranasally 20 μl, the ninth group of animals received a physiological solution intra -abdominal 0.2 ml. The behavior of animals was studied using the tests “Open Field”, “Raised Cross Labyrinth” and “Sexual Motivation”. Results. In the present study stable and dose-dependent effects of kisspeptin-10 on the behavior of rats after intranasal administration were obtained. Intranasal kisspeptin-10 caused a significant increase in sexual motivation, an increase in horizontal and vertical motor activity, a decrease in stress, and an increase in exploratory activity in sexually mature male rats. The greatest changes in behavior were caused by a dosage of 10 μg and the central effect of kisspeptin-10 on the brain after intranasal administration in comparison with groups of animals after intraperitoneal administration. While the indicators after intraperitoneal administration of kisspeptin-10 caused virtually no changes in behavior at doses of 1 and 10 μg. Increasing the dosage to 100 μg intraperitoneally showed a significant change in behavior, but not as strong as after intranasal administration of the substance in an amount of 10 μg. Conclusions. To significantly change behavior, intranasal administration required concentrations 10 times lower than intraperitoneal administration. Based on the apparent effects of kisspeptin-10 after intranasal administration in each test, it can be assumed that kisspeptin-10 penetrated into the brain, bypassing the BBB and exerting a central effect. The data confirm the potential and significance of this method of delivering the substance to the central nervous system.
ANALYSIS OF THE VIGIBASE DATABASE FOR EFFECTIVE SAFETY MONITORING OF POAC USE IN ELDERLY AND SENIORS WITH CHRONIC KIDNEY DISEASE
Objective. The objective of this study was to analyze the VigiBase database, which reflects clinical data of patients taking direct oral anticoagulants (apixaban, rivaroxaban, endoxaban, and dabigatran). Methodology. A database from the VigiBase service was selected for the study. A database on the use of apixaban, rivaroxaban, endoxaban, and dabigatran was collected. The algorithm for searching clinical cases was as follows: patient data were exported to an EXEL table, and an age limit of over 65 years was set in the program. After that, the database was sorted by the presence of chronic kidney disease. The criterion for CKD was information entered into the table, which was found by the keywords "Renal disorder", "Renal function test abnormal", "End stage renal disease". As a result, the following patients were selected: 3289 (apixaban), 2392 (rivaroxaban), 1034 (endoxaban), 3268 (dabigatran). Fatal and non-fatal DOAC-dependent complications, as well as drug interactions, were assessed in these groups. Results. The analysis identified factors that, if taken into account, could potentially increase freedom from hemorrhagic complications in a cohort of geriatric patients with chronic kidney disease. In the studied cohort, non-fatal hemorrhagic complications were most often encountered when taking dabigatran - 18.4%, which statistically significantly distinguished this group from patients taking "xabans". Among "xabans", apixaban had the lowest prevalence of both fatal and non-fatal hemorrhagic complications. Drug interactions that increase the risk of hemorrhagic complications were identified - dabigatran + atorvastatin and furosemide + apixaban. VigiBase is a database containing a large amount of data on drug interactions, adverse effects of medications, and mortality. Conclusion. This database is of great interest from the point of view of conducting analytical studies, since it allows finding statistical relationships in large samples, has a high potential for selecting randomized and comparable groups.
THE EFFECTIVENESS OF LIQUID ORAL HYGIENE PRODUCTS FOR THE PREVENTION AND TREATMENT OF ORAL DISEASES
Objective. To analyze and summarize literature sources and patent information in the field of development of liquid oral hygiene products and their role in increasing the effectiveness of prevention. Methods. Analysis and synthesis of scientific and patent literature was carried out using the information retrieval system in the field of medicine PubMed, ScholarGoogle, electronic library database eLibrary, electronic library systems IPR SMART (IPR BOOKS), electronic medical library on the BookUp platform, foreign electronic resources of publishing houses Springer Nature and Elsevier. Results. The review found that existing liquid oral hygiene products are designed to rinse, cleanse and freshen the mouth, enhance the natural protective system of saliva, maintain a healthy balance of microflora in the mouth, and prevent gum swelling and bleeding. Currently, a large number of liquid oral hygiene products and methods for their use have been developed, but the search and testing of new products does not lose its relevance. Conclusion. Despite the fact that liquid oral hygiene products are additional oral hygiene products, they significantly increase the effectiveness of basic products for the prevention and treatment of oral diseases, enhancing their effect, cleaning hard-to-reach interdental spaces, and freshening breath. In addition, they are distinguished by convenience and ease of use.
NEUTROPHIL-LYMPHOCYTIC INDEX IN PATIENTS WITH CHRONIC MUCOPURULENT BRONCHITIS IN DYNAMICS
Objective. To calculate and analyze the neutrophil-lymphocyte index and its dynamics in patients with chronic mucopurulent bronchitis after 12 months of observation. Methods. A total of 92 patients with chronic mucopurulent bronchitis were followed up for 12 months. After 12 months, bronchiectasis was detected on OHC CT in 29 patients. NLI, which is the ratio of neutrophils to lymphocytes in the general blood count, was determined twice - at the beginning and at the end of follow-up. Results. At the end of the study, patients with bronchiectasis had higher NLI values than patients without bronchiectasis formation. Among the patients with CSHD who did not have bronchiectasis formation during the observation period: in 39 patients the NLI decreased, in 4 patients it increased and in 20 patients - did not change. Among patients with CSHD in whom bronchiectasis formation occurred during the observation period: 0 - NLI decreased, in 27 patients NLI increased and in 2 patients NLI did not change - NLI increased and in 2 people - NLI did not change. Conclusion. NLI is one of the promising predictors of bronchiectasis development in patients with CSHD. The absence of its decrease during dynamic observation allows predicting the formation of this complication.
LEVEL OF APOPTOSIS MARKERS IN PATIENTS WITH MYOCARDIAL INFARCTION AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE DEPENDING ON THE NUMBER OF AFFECTED ARTERIES
Objective. To study the levels of apoptosis markers in patients with myocardial infarction associated with chronic obstructive pulmonary disease depending on the number of affected coronary arteries. Methods. Three study groups were formed: the main group included 195 patients with myocardial infarction associated with chronic obstructive pulmonary disease; the comparison group included 130 patients with myocardial infarction without chronic obstructive pulmonary disease; the control group included 110 somatically healthy individuals. Results. Increased apoptosis of circulating mononuclear cells was observed both in patients with myocardial infarction and in the group of comorbid patients compared to the control group, which was manifested by a decrease in the number of intact cells with a simultaneous increase in apoptotic and necrotic cells. The maximum severity of apoptotic processes was observed in comorbid patients. The severity of apoptosis was also greater in patients with damage to 2 or more arteries compared to patients with single-vessel damage. Conclusion. The maximum severity of apoptotic processes was revealed in patients with myocardial infarction associated with chronic obstructive pulmonary disease, which is probably due to the intensification of apoptosis during the development of chronic systemic inflammation accompanying both nosologies. A greater severity of apoptosis was also found in patients with damage to 2 or more arteries, which confirms the correlation between apoptosis processes and the volume of myocardial damage.
INFLUENCE OF SIPING AND COMPUTER ELECTROACUPUNCTURE ON THE VEGETATIVE STATUS OF PATIENTS WITH ALLERGIC BRONCHIAL ASTHMA
Objective. to evaluate the effect of computer electroacupuncture and siping on the state of the autonomic nervous system in patients with allergic bronchial asthma in the acute stage. Methods. The study included 60 patients with bronchial asthma with a predominant allergic component (in the acute stage). Patients were randomized into groups I, II and III (20 people in each group). All patients received standard drug treatment. Patients in group I additionally received a course of siping; in group II, patients received a course of computer electroacupuncture; patients in group III received only standard drug treatment. The study design involved three-fold determination of the Kerdo autonomic index. Results. The first siping procedure led to an increase in the proportion of patients with normotension, and five siping procedures were accompanied by a further increase in the proportion of patients with normotension. In group II, after the first session of computer electroacupuncture, the proportion of patients with normotension also increased statistically significantly; after 5 sessions of computer electroacupuncture, the proportion of patients with normotension was the highest among other observation groups. In group III, no significant changes in the proportion of patients with normotension were registered during the study. The greatest decrease in the module of the Kerdo index values was registered in patients with initial sympathicotonia or parasympathicotonia in groups I and II. Conclusion. The inclusion of sipping nutrition or computer electroacupuncture in the complex treatment of exacerbation of allergic bronchial asthma leads to a more significant effect on the Kerdo index, compared with isolated standard pharmacotherapy.
FACTORS INFLUENCING THE SUCCESS OF THE ALIGNMENT OF THE LENGTH OF THE LOWER EXTREMITIES IN TOTAL HIP REPLACEMENT
Objective. Determination of indications for alignment of the length of the lower extremities during total hip replacement. Methods. A survey was conducted of patients who were diagnosed with coxovertable syndrome. All patients had a difference in the length of the lower extremities, which ranged from 3 to 12 cm. The length of the lower limbs was estimated using an orthorentgenogram. Results. The results of limb length correction at the end of the studies were divided into 3 variants. In the first case, the length of the limbs was equalized, in the second, the differences in the length of the limbs remained, and the third option was made up of persons with excessive limb elongation. Conclusion. The results of the study showed that such factors include age, duration of coxovertebral syndrome, initial differences in limb length, a history of surgery, joint stiffness. These factors should be taken into account when planning hip replacement surgery and, if available, special preoperative preparation should be carried out.
CLINICAL FEATURES BEFORE AND AFTER CAROTID ENDARTERECTOMY IN PATIENTS WITH SEVERE ATHEROSCLEROTIC LESIONS OF THE INTERNAL CAROTID ARTERY
Objective. To study was to evaluate the clinical picture in patients with severe ICA stenosis (˃ 60%) and phlebohypertension before and at different times after CEAE. Methods. Thirty patients (21 men and 9 women) aged 55 to 69 years with severe atherosclerotic lesions of the ICA ˃ 60% were examined. All patients had confirmed phlebohypertension according to the method of M.V. Shumilina. All underwent eversion CEAE. A collection of complaints with an assessment of the severity of symptoms using a visual analogue scale was conducted before surgery, on days 10-14 after CEAE, and after 6 and 12 months. Results. The data showed no relationship between dizziness and tinnitus and the timing of the postoperative period. Weakness and headache statistically significantly appeared more often on days 10-14 after surgery. There was a significant increase in the intensity of complaints on days 10-14 after surgery and then with a return to the initial level: dizziness, tinnitus (p˃0.05), or a statistically significant decrease in severity: weakness and headache (p˂0.01). Conclusions. Given the nonspecificity of complaints in patients with severe ICA stenosis and phlebohypertension, we consider it appropriate to perform ultrasound dopplerography of the brachiocephalic pool vessels with an assessment of the venous outflow tract and measurement of venous pressure before surgery and at the recommended times after.
RADIATION MARKERS OF KIDNEY INJURY IN PATIENTS IN INCREASED INTRA-ABDOMINAL PRESSURE SYNDROME WITH PANCREATITIS
Objective. To evaluate radiation markers of kidney injury in patients in increased intra-abdominal pressure syndrome with pancreatitis. Methods. 48 patients of the intensive care unit with diagnosis of pancreatitis underwent kidney MRI upon admission with an assessment of qualitative and quantitative parameters of DWI and ASL - perfusion, assessment of GFR, intra-abdominal pressure (IAP). Based on the IAP results on the day of admission, patients were divided into 4 groups. Statistical processing - Microsoft Excel 2019 and Jamovi, version 2.6.26. Results. On admission, all patients had GFR>60 ml/min×1.72 m2, IAP by groups: I - 12-15.9 mmHg (n=10), II - 16-20.9 mmHg (n=15), III - 21-25 mmHg (n=15), IV - more than 25 mmHg (n=8). MRI of the kidneys: Group I - ASL perfusion = 286.5 (258.6; 314.4) ml/100 g/min, qualitative DWI - false diffusion limitation, ADC = 2.77 (2.65; 2.89) × 10-3 mm2/sec., II - ASL perfusion = 282.2 (261.4; 299) ml/100 g/min, ADC = 1.67 (1.51; 1.79) x 10-3 mm2/sec., qualitative DWI - signs of true diffusion limitation in 3 patients, false - in 12. III - ASL perfusion = 264.6 (246.34; 282.86) ml/100 g/min, qualitative DWI - true diffusion limitation, ADC = 1.33 (1.05; 1.61) × 10-3 mm2/sec, IV - ASL perfusion = 234.1 (221.8; 246.1) ml/100 g/min, qualitative DWI - true diffusion limitation, ADC = 1.18 (1.04; 1.32) × 10-3 mm2/sec. In groups III-IV, the fatal outcome within 5-11 days is 100%. (r = 0.959, r = 0.763). In group II, patients have negative dynamics, fatal outcome in 3 patients. Group I with a good outcome. Conclusion. Qualitative assessment of kidney DWI in patients with elevated IAP is a predictor of death during hospitalization (r=0.959). Qualitative assessment of DWI, ADC and ASL perfusion have a negative correlation with elevated IAP (r=0.832, r=0.839, r=0.849). Increased IAP determines the outcome of hospitalization (r=0.813). Kidney MRI should be performed in patients with pancreatitis to assess for signs of elevated IAP and renal damage.
PATHOGENETIC ASPECTS OF ANGIOPATHIES AND DAMAGE TO THE VASCULAR ENDOTHELIUM IN TYPE 1 DIABETES MELLITUS
Objective. Identification of the leading mechanisms of endothelial dysfunction formation in type I diabetes mellitus based on literature analysis. Methods. Based on the analysis of literary data, the main mechanisms of endothelial dysfunction development and its consequences in patients with type I diabetes mellitus were identified. Results. Based on the analysis of literature data, the main mechanisms of endothelial cell damage with impaired production of vasoactive substances and development of vascular complications in type 1 diabetes mellitus were studied. They include increased expression of selectin family adhesion molecules, impaired regulation of vascular tone due to insulin deficiency, damaging effects of oxidative stress, non-enzymatic glycosylation and decreased production of nitric oxide due to prolonged hyperglycemia. These damages leads to disorders of the vasomotor, barrier, angiogenic functions of the endothelium, and a decrease in its thromboresistance. Conclusion. Endothelial dysfunction is a predictor of vascular complications of type I diabetes mellitus. According to modern literary data, is formed both due to prolonged hyperglycemia, which results in the recruitment of endothelial precursor cells into the peripheral circulation, and is the result of oxidative stress, non-enzymatic glycosylation, which must be taken into account in the pathogenetic therapy of diabetic angiopathies.
MALIGNANT ARTERIAL HYPERTENSION: MODERN CONCEPTS OF PATHOGENESIS, DIAGNOSTIC CRITERIA AND TREATMENT
Objective. To evaluate diagnostic criteria and risk factors for malignant arterial hypertension (MAH), to analyze current capabilities for differential diagnostics and treatment of MAH. Methods. To collect, systematize, and analyze literature data demonstrating new pathogenetic links and diagnostic criteria for MAH, the role of thrombotic microangiopathy, and approaches to treating this condition. Results. MAH is a special pathophysiological form of severe hypertension with rapid disease progression and poor prognosis associated with systemic damage to target organs, often as a result of thrombotic microangiopathy. The main causes of death in patients with MAH are progressive renal failure (34.7%), stroke (19.8%), heart failure (10.9%), and myocardial infarction (10.4%). An important pathological feature of ZAG is endothelial dysfunction and fibrous necrosis of arterioles, which obviously affects various tissues and damages target organs: kidneys, heart and brain. TMA syndrome is typical for 27-44% of patients with ZAG, but it requires careful exclusion of other causes. The goal of therapy is to reduce blood pressure to a safe level, correct lifestyle to reduce the risk of cardiovascular diseases, prevent the occurrence of associated clinical conditions and damage to target organs. Conclusion. ZAG is a special pathophysiological form of severe hypertension with rapid disease progression and poor prognosis. The greatest threat in ZAG syndrome is renal damage with endothelial damage, intravascular blood coagulation and thrombotic microangiopathy and outcome in nephrosclerosis.
ARTIFICIAL FEEDING: MODERN TRENDS IN IMPROVING THE COMPOSITION OF INFANT FORMULAS BASED ON GOAT'S MILK
Objective. A summary of research focused on improving the formulation of infant formulas based on goat's milk. Methods. The search for relevant information was carried out in the Russian-language search system eLibrary and the English-language databases PubMed. BMC, Scopus. Of the selected publications, the most significant domestic and foreign works were used for analysis. Results. The review presents an analysis of key areas for improving formulas for infant formulas based on goat milk. An assessment of potential changes in the quantitative and qualitative content of key components of formulas is made, taking into account age characteristics and dietary needs of the child's body. The possibility of combining milk from different types of farm animals (goats and sheep) in the production of modern lines of basic adapted, dietary-preventive and specialized nutrition for children from birth is considered. Conclusion. Combining milk components from different types of farm animals is another promising way to create more advanced adapted formulas for supplementary feeding or artificial feeding.
Objective. The study of known methods of treatment of deformity of the lower limb by the type of hollow foot and the definition of variations in their application. Methods. Collection, systematization and analysis of scientific literature data on the topic of treatment of hollow foot. The research was based on the Pubmed website, the Google Scholar electronic scientific library. Results. A hollow foot is a term that covers a range of deformities. Often, this pathology is secondary to neurological disorders. Determining the underlying cause and pathological anatomy in a particular patient is necessary to prescribe appropriate treatment. The main anatomical component of the deformity and the presence of rigidity of the posterior or anterior part of the foot will help determine the necessary surgical intervention. Surgical treatment is usually complex and individual in terms of the selection of stages, but a combination of soft tissue interventions and osteotomy/arthrodesis usually allows you to achieve a plantar position of the foot and thereby improve the patient's gait. Conclusion. A mild or moderate deformity of the type of hollow foot creates a dilemma in terms of making a surgical decision. The decision to perform an osteotomy or arthrodesis is not always clear. Options that preserve joint mobility are preferred. Such surgical techniques include osteotomy, and arthrodesis is used to save an unsuccessful correction or in severe deformity. It is worth noting that surgery is not an inevitable stage of treatment. Orthopedic devices and shoe modification help patients well in the presence of mild and no progression of the hollow foot.
THE USE OF IMPLANTS MADE OF MAGNESIUM BIORESORBABLE ALLOYS IN TRAUMATOLOGY AND ORTHOPEDICS. LITERATURE REVIEW
Objective. The aim of the study was to assess and analyze current data on modern magnesium fixators, evaluate the advantages of their clinical use, identify risks and problems when used in Orthopedics and Traumatology. Methods. The review was prepared using publication databases elibrary.ru, Google Scholar and PubMed. This literature review is not a systematic analysis. Results. Various implants consisting of bioresorbable materials are widely used to reduce postoperative complications. In modern traumatology and orthopedics, magnesium metal fixators are applied along with classical fixing systems made of polymer and ceramic materials. Conclusion. The analyzed sources describe technical, biochemical and physiological aspects of the use of magnesium fixators in clinical practice.
PATHOGENETIC FEATURES OF IMMUNE SYSTEM DISORDERS IN ELDERLY PATIENTS WITH CHRONIC PERIODONTITIS
Objective. To identify the main immunological factors contributing to the development of chronic periodontitis in old age. Methods. A review of modern literature on the main directions of periodontal disease pathogenesis, as well as studies on changes in different parts of the immune system among older individuals and their interactions. Results. With age, there is a decline in the number and function of cells involved in innate and adaptive immunity. Older adults experience impairments in neutrophils, macrophages, dendritic cells, and natural killer cells, as well as phagocytic systems, leading to reduced effectiveness in fighting infection. Additionally, there is an imbalance in inflammatory mediators, T lymphocytes, and B cells production. These changes in the immune system result in immunosuppression and make older individuals more susceptible to infectious and autoimmune conditions. The level of pro-inflammatory cytokines in the blood increases, such as IL-6, TNF and RANKL, which limits reparative processes and contributes to the spread of periodontal disease. Conclusion. Therefore , an insufficient immune response, bone resorption, and a decrease in fibroblast numbers contribute to the persistence of pathogenic microorganisms, inflammation, metabolic changes, local homeostasis disruption, and remodeling. A deep understanding of the key stages in the immune pathogenesis of periodontal disease opens up new possibilities for treatment and diagnosis. It also allows for the selection of appropriate pathophysiological correction methods and development of effective prevention strategies.
TOTAL KNEE ARTHROPLASTY USING THE CUVIS ROBOTIC SYSTEM FOR COMPLEX COMBINED DEFORMITIES
Objective. To evaluate the efficacy of robotic-assisted TKA using the CUVIS system for combined knee joint deformities. Methods. We present a case of a 68-year-old female with grade IV gonarthrosis (Kellgren-Lawrence classification), 24° varus deformity, and 28° flexion contracture. Robotic-assisted total knee arthroplasty was performed using the CUVIS system. Preoperative planning included CT scanning and 3D modeling for deformity correction. Intraoperatively, the system ensured precise execution of the surgical plan, achieving mechanical axis restoration to 0°±1° with optimal soft tissue balancing. Results. The Cuvis robotic system enabled high-precision correction, restoring the mechanical axis to 0° (error ≤1.5°) and achieving full range of motion (0-0-130°). Six-month follow-up demonstrated significant clinical improvement: VAS pain score 1, Lequesne index 2, KSS 165, and IKDC score 75, indicating excellent functional recovery and patient satisfaction. The system's technical capabilities allow its use both in standard TKA cases and for correcting minor tibial condyle bone defects when augments are clinically justified. Conclusion. The autonomous CUVIS robotic system provided accurate preoperative planning and complete correction of severe combined deformities during knee arthroplasty.
CLINICAL AND EPIDEMIOLOGICAL PARTICULAR QUALITIES INFANTS’ SCABIES: ANALYSES OF THE CLINICAL CASE OF THE INFANT’S SCABIES
Objective. To determine the clinical and epidemic features of the modern course of scabies in children of the first year of life using the example of the analysis of a clinical case of a family focus with the involvement of a newborn in the infectious process. Methods. Comparative analysis of statistical data on the incidence of scabies in the Russian Federation and the Kaluga region based on reporting and accounting materials for the period 2021-2024. Clinical, epidemiological and laboratory methods of analyzing data from 5 medical records of patients with scabies (registration accounting form №025), forming a family focus of the disease. Results. As a result of everyday communication in a family whose members are infected with the scabies mite, with the development of scabies in newborns, widespread, disseminated forms with a tendency to erythroderma develop, including anatomical areas atypical for localization (face, neck) and rapid addition of secondary infection, which can simulate pyoderma, microbial eczema, as well as the risk of developing scabies lymphoplasia. Conclusions. Statistically significant differences in the incidence of scabies among the population of the Kaluga Region were established, with a predominance in the age structure of persons under 14 years of age against the background of a general stable trend of epidemic growth and spread of scabies.
APPLICATION OF THE EXPERT EVALUATION SYSTEM IN CHOOSING A GEL BASE FOR THE DEVELOPMENT OF A TOPICAL GEL
Objective. The study aims to assess the application of an expert evaluation system in choosing a gel base for the development of a topical gel. This system allows for efficient analysis of various bases and optimization of their selection based on several criteria. Methods. The Analytic Hierarchy Process (AHP) method was applied, which aids in decision-making through a structured evaluation of the problem's elements. Expert opinions were converted into weight coefficients for each alternative, allowing the establishment of priorities based on criteria such as spreadability, covering ability, and viscosity change in gels. Results. The analysis showed that a gel based on hydroxypropyl methylcellulose (HPMC) at a 1.5% concentration demonstrated the best spreadability, ensuring uniform distribution on the skin. A gel based on carbopol at a 1.5% concentration exhibited the highest covering ability, while gels with sodium carboxymethyl cellulose (CMC-Na) at concentrations of 3.5-4.5% showed the greatest viscosity stability. Conclusion. The results indicate that a carbopol gel at a 1.5% concentration and an HPMC gel at a 2% concentration are the best options for developing topical formulations. The use of the expert evaluation system and the AHP method significantly optimized the process of selecting gel bases, ensuring precision and decision-making efficiency.
STUDY OF THE POSSIBILITY OF IMPLEMENTING LOYALTY PROGRAMS FOR RUSSIAN PHARMACIES IN THE PHARMACEUTICAL MARKET OF SYRIA
Objective. The study is aimed at studying loyalty programs used in Russian pharmacies and their potential for the Syrian pharmaceutical market. The authors set the task, based on the analysis of Russian loyalty programs, to propose the most successful ones for implementation in Syria, in order to increase the stability and satisfaction of pharmacy customers. Methods. Both qualitative and quantitative methods have been used in the analysis. The authors analyzed scientific articles, and statistical data on loyalty programs in Russia and Syria. Various forms of loyalty programs, their structure, and features of application in Russian pharmacies were considered. Results. The study examined various loyalty programs widely used in pharmaceutical organizations in Russia. It was found that the most popular programs are those that include accumulative points, multi-level rewards and bonuses for referrals. As a result, the authors determined that programs based on the accumulation of points represent the greatest value for the Syrian market, given its characteristics. Other programs, such as referral bonuses, may be less effective due to the financial constraints of Syrian pharmacies. Conclusion. Developing loyalty programs can contribute to the sustainable development of Syrian pharmacies, increasing customer satisfaction and long-term relationships with them. The most promising is a point-based rewards program, which is easy to implement and meets the needs of Syrian customers for affordable medicines.
PECULIARITIES OF TOXIC MICROELEMENTS ACCUMULATION IN MEDICINAL PLANT RAW MATERIALS OF THE CENTRAL BLACK EARTH REGION
Objective. The purpose of the experimental study of the content of toxic trace elements in wild-growing medicinal plant raw materials of natural ecotopes of the Voronezh region. Methods. Pharmacopoeial types of herbal raw materials were used as the objects of the study: common burdock ( Arctium lappa L.) roots, dandelion medicinal ( Taraxacum officinale F.H.Wigg) roots, plantain large ( Plantago major L.) leaves, nettle dioecious ( Urtica dioica L.) leaves, heart-shaped linden ( Tilia cordata Mill.) flowers, common tansy ( Tanacetum vulgare L.) flowers, wormwood bitter ( Artemisia absinthium L.) grass, motherwort five-lobed ( Leonurus quinquelobatus Gilib.) grass, common yarrow ( Achillea millefolium L.) grass, bird highlander ( Polygonum aviculare L.) grass. The microelement composition of the samples was studied by mass spectroscopic method after acid-microwave decomposition. Results. Among the determined toxic elements, cadmium is strongly accumulated from soils in a number of types of plant raw materials. Mercury accumulates strongly in nettles of dioecious leaves. The average level of biological absorption was noted for lead, bismuth and barium - mainly in the studied roots and leaves of plants. Conclusion. The results of the study of the microelement composition of the studied types of medicinal plant raw materials can be used in medical and pharmaceutical practice.
STUDY OF PECULIARITIES OF ACCUMULATION OF BIOLOGICALLY ACTIVE SUBSTANCES IN ROOTS OF DANDELION OF MEDICINAL SYNANTHROPIC FLORA OF ROSTOV REGION
Objective. The purpose of the study is to study the peculiarities of the accumulation of biologically active substances extracted by water in the roots of the dandelion of the medicinal synanthropic flora of the Rostov region. Methods. Several sampling points for medicinal plant raw materials within the Morozovsky district were selected for the studies. The choice of harvesting areas is due to the lack of accurate information on the accumulation of biologically active substances in the SRS, depending on the distance from highways and railways. Additionally, the roots of burdock were harvested in environmentally friendly areas located far from commercial facilities (control zones). The content of the total extractive substances extracted with water in the selected samples of dandelion roots was determined according to the standard pharmacopoeial method. Results. The obtained values of the content of extractive substances extracted by water show the presence of a direct correlation in increasing the content of the studied group of biologically active substances with increasing distance from all the studied highways. At the same time, in the roots of the dandelion harvested near the industrial enterprise and in the control areas the results of the study show little difference, indicating the lack of influence of this type of anthropogenic pressure on the studied group of biologically active substances. Conclusion. Depending on different regional conditions and the degree of influence of anthropogenic impact, the content of extractive substances in the roots of dandelion varies, but indicates the presence of a relationship between the increase in the content of extractive substances when moving away from highways, as well as the general pattern of induction and inhibition of biosynthesis of biologically active substances.
STUDY OF CONDITIONS FOR QUALITATIVE ANALYSIS OF FLAVONOIDS OF THE HERB ASTRAGALUS GLYCYPHYLLUS L
Objective. To develop a method for the qualitative determination of the amount of flavonoids in the herb of Astragalus glycyphyllus. Methods. The object of the study was the herb of Astragalus glycyphyllus, harvested in 2023-2024 in the Kursk and Oryol regions. The presence of flavonoids in the studied raw materials was determined using well-known qualitative reactions. For the separation and identification of individual flavonoids, the method of thin-layer chromatography on Sorbfil plates was used. Optimal conditions for the experiment were established empirically: the method of raw material extraction, the choice of chromatographic plates, the solvent system, the sample volume for analysis, standard substances and the developing agent. Results. Using qualitative reactions in extracts from the herb of Astragalus glycyphyllus the presence of flavonoids was established. Optimal conditions for the qualitative analysis of flavonoids in the herb of the studied plant were experimentally determined using thin-layer chromatography: chromatography was performed in an ascending manner, the solvent system was chloroform-alcohol 96%-water (26:16:3), and hyperoside CO and astragalin from Fitopanatseya LLC were used as witness substances. After drying, the chromatogram was treated with a 5% solution of aluminum chloride in ethyl alcohol and examined in UV light. As a result of the experiment, five compounds belonging to flavonoids were detected, including astragalin and hyperoside. The developed technique was validated for: specificity, precision and robustness. Conclusions. A method for the qualitative determination of flavonoids in the herb of Astragalus glycyphyllus has been developed. Optimal conditions for extracting flavonoids from raw materials and performing thin-layer chromatography have been established. The developed method has been validated for specificity, precision, and robustness. The presence of flavonoid compounds in the plant under study indicates the possibility of using the herb of Astragalus glycyphyllus as a source of natural antioxidants.
CHROMATOGRAPHIC STUDY OF PHENOLIC COMPOUNDS OF LEAVES OF CORNUS AUSTRALIS
Objective. To study the phenolic compounds of the leaves of southern dogwood. Methods. The leaves of the southern dogwood were harvested during the flowering period in natural habitats in the vicinity of Pyatigorsk, Stavropol Krai, in June 2022-2024. Thin-layer chromatography and high-performance liquid chromatography were used to diagnose phenolic substances in the raw materials. The analysis was carried out based on the requirements of the State Pharmacopoeia, XV edition. Results. The presence of the following phenolic substances in the leaves of the southern dogwood was established: phenolic carboxylic acids (gallic, caffeic, chlorogenic, ferulic), flavonoids (rutin, luteolin-7-O-glycoside), coumarins (umbelliferone). Conclusion. Based on the data obtained, it can be concluded that the leaves of the southern dogwood represent a promising object for further research in order to develop herbal preparations with antioxidant action.
EVALUATION OF THE BIOSTIMULATING EFFECT OF THE INFUSION OF THE COLLECTION WITH SEDATIVE ACTION IN VITRO USING THE PARAMECIUM CAUDATUM TEST SYSTEM
Objective. primary assessment of the biocidal or biostimulating effect of the infusion of individual components and the infusion of the sedative collection in vitro using the Paramecium caudatum test system with the help of the automated hardware and software complex "BioLat 3.2". Methods. The studies were conducted using the automated hardware and software complex "BioLat 3.2" manufactured by Evropolitest LLC, Russia. The device operates on the principle of converting a video image of a well with test organisms into a digital signal, which is transmitted to a computer via a USB port, using the Parametium caudatum ciliate test system. Results. It was established that the infusion of the sedative collection containing horse chestnut flowers, knotweed herb, St. John's wort herb, blue cornelian herb in a certain ratio is characterized by low toxicity in relation to the cellular in vitro test system and exhibits a biostimulating effect, which is confirmed by a significant reliable increase in the number of ciliates by 44% compared to the average control sample and 2 times compared to the initial indicator of the experimental sample during incubation for 24 hours. Conclusion. The infusion of the collection has a sedative effect, is characterized by low toxicity in relation to the cellular in vitro test system and exhibits a biostimulating effect.
COMPARATIVE RESEARCH OF MYRTUS COMMUNIS L. LEAVES AQUEOUS AND AQUEOUS-ALCOHOLIC EXTRACTS AND ESSENTIAL OIL ANTIMICROBIAL ACTIVITY
Objective. Comparative analysis of antimicrobial activity of water-alcoholic extracts and essential oil of leaves of common myrtle ( Myrtus communis L.) with the control preparation - tincture of eucalyptus 70%. Methods. The objects of the study were aqueous-alcohol extracts of leaves of common myrtle at concentrations of ethyl alcohol 40% and 80% in the ratio “raw material - extractant” (1:5), tincture of common myrtle 70%, standard samples of myricitrin and gallic acid, as well as a commercial sample of essential oil of common myrtle. The control objects for comparison were eucalyptus tincture and ethanol. The following strains were used as test cultures: Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Candida albicans (clinical strain). Determination of MIC was carried out by double serial dilutions in broth (test tube, macromethod). Mueller-Hinton nutrient broth was used as a nutrient medium. The results were assessed visually by the presence/absence of microbial growth in test tubes with appropriate dilutions of the samples under study. Results. As a result of the conducted studies, there was shown that: samples of tinctures from leaves of common myrtle on 70% and 80% ethyl alcohol have comparable antibacterial activity, and more pronounced in comparison with tincture of myrtle on 40% ethyl alcohol and tincture of eucalyptus (industrial sample); samples of water-alcohol extracts from leaves of common myrtle on 70% and 80% alcohol show the greatest antimicrobial activity against S. aureus, P. aeruginosa, C. albicans ; aqueous extract of common myrtle was active against strains of S. aureus, P. aeruginosa, C. albicans , outperforming eucalyptus tincture and ethanol, which is most likely due to the presence of gallic acid; the essential oil of common myrtle did not show significant antimicrobial activity compared to eucalyptus tincture and ethanol against the strains of pathogenic microorganisms used in the study, which may be due to the peculiarity of the component composition of the raw material from which the industrial sample was obtained; antimicrobial activity of standard samples of myricitrin and gallic acid was comparable or inferior to the results of control samples, which may be due to the fact that these BAS for the inhibition of pathogenic strains need the presence of other components of water-alcoholic extract, such as tannins. Conclusion. The results obtained during the study can serve as a basis for the preparation of a draft pharmacopoeial article for a new type of medicinal raw plant - “Common myrtle leaves”, the creation of new antibacterial medications based on common myrtle leaves, as well as for further introduction of preparations of myrtle leaves tincture on ethyl alcohol 70% in medical and pharmaceutical practice.
PLANT SOURCES OF PHENOLIC COMPOUNDS - THE BASIS FOR THE DEVELOPMENT OF DRUGS FOR THE TREATMENT OF DISEASES OF THE GENITOURINARY SYSTEM
Objective. The purpose of this study is to develop a diuretic collection for the treatment and prevention of urolithiasis and to standardize it. Methods. The study used official types of raw materials: Equiseti arvensis herba, Polygoni avicalaris herba, Vaccinii vitis-idaeae folia, Zeae maydis styli cum stigmatis , as well as Solidaginis dahuricae herba , which is promising for introduction into medical practice. The studies on standardization of the collection were conducted in accordance with OFS.1.4.1.0020 "Collections". When selecting the collection components and their ratios, the sum of phenolic compounds was determined using permanganometric titration. Analytical reactions and thin-layer chromatography were used to identify flavonoids and simple phenols. The sum of extractive substances was determined in accordance with OFS.1.5.3.0006. On the devices SF-2000 (Ekonova, Russia) and Leki SS1207 (Mediora OY, Finland) set the amount of flavonoids by differential spectrophotometry, the amount of simple phenols - by direct spectrophotometry after purification on a column. The results are processed statistically validated. Results. For the collection of diuretic (for urolithiasis) proposed components that are sources of flavonoids and simple phenols, with their equal optimal ratio. Established external and diagnostically significant microscopic features. For qualitative analysis, a thin-layer chromatography technique was proposed, where the mobile phase and chromogenic reagent are butanol-acetic acid-water 4:1:2 and 2% aluminum chloride solution (for flavonoids); ethyl acetate-acetone-glacial acetic acid-water 75:45:15:30 and 10% phosphomolybdic acid solution (for simple phenols). The content of extractive substances is regulated at least 25.0%, flavonoids (in terms of rutin) - at least 2.0% and simple phenols (in terms of arbutin) - at least 0.6%. Proposed norms of moisture content, total ash and ash insoluble in hydrochloric acid, impurities. Conclusion. The composition has been developed, the quantitative content of flavonoids and simple phenols has been established, and the diuretic collection has been standardized (for urolithiasis).
ANALYSIS OF THE RANGE OF DELAYED-ACTING SYMPTOMATIC DRUGS IN THE RUSSIAN PHARMACEUTICAL MARKET
Objective.Тo perform a structural analysis symptomatic delayed-acting drugs assortment on the Russian pharmaceutical market. Methods. The study was conducted on the basis of data from the State Register of Medicines, instructions for the medical use of medicines, official websites of pharmacies in Perm using structural and graphical methods and content analysis. Results. In the Russian pharmaceutical market, symptomatic delayed-acting drugs are represented by 8 international nonproprietary names, 68 trade names in the form of 84 medicines. These drugs are mainly produced in Russia (78.5%). Each international nonproprietary name is analyzed in terms of dosage forms, ATC classification, interchangeability, as well as the actual availability of drugs in the assortment of pharmacies in Perm as of December 2024. Conclusion. The Russian pharmaceutical market of delayed-acting symptomatic drugs is characterized by a wide range, mostly produced in Russia. These drugs are available in forms for internal, parenteral and external use. An analysis of the actual assortment in the city of Perm showed the presence of drugs of most international nonproprietary names in all pharmacies studied. The List of Interchangeable medicines for medical Use includes 6 international nonproprietary names.
STUDY OF MEDICAL-DEMOGRAPHIC AND SOCIAL PORTRAIT OF PATIENTS WITH CHRONIC MYELOID LEUKEMIA FOR PROVISION OF PERSONALIZED PHARMACOTHERAPY TO PATIENTS OF TYUMEN REGION
Objective. To conduct an analysis of the medical, demographic and social profile of patients with chronic myeloid leukemia (CML) to provide high-quality, safe and effective pharmacotherapy taking into account the individual characteristics of each patient in the Tyumen region. Methods. The study was conducted at the Department of Hematology and Chemotherapy of the Regional Clinical Hospital No. 1. A total of 183 medical records of patients with chronic myeloid leukemia were analyzed. Analytical, statistical, graphical, and mathematical methods were used. Results. The analysis showed that the average patient with CML in the Tyumen region is a woman (55%), of retirement age (60-69 years), is observed in the Tyumen municipal district (69%), takes Imatinib (74%), among concomitant diseases most often there are diseases of the circulatory system (23.7%). The average age of patients was 55 years, the diagnosis of chronic myeloid leukemia was most often established at the age of 47 years. The main preferential categories are: 964 - High-cost nosologies, 81 - Disabled 3 groups, 937 - Citizens suffering from hematological diseases. Conclusion. Based on a detailed analysis of the selected parameters from the medical records of patients with chronic myeloid leukemia, a medical-demographic and social portrait of patients with chronic myeloid leukemia in the Tyumen region was compiled to provide high-quality, safe and effective pharmacotherapy, taking into account the individual characteristics of each patient in the Tyumen region.
COMPARATIVE EVALUATION OF THE QUALITY OF MEDICINAL SHAMPOOS WITH KETOCONAZOLE AND BIRCH TAR
Objective. To conduct a comparative assessment of the quality of medicinal shampoos with ketoconazole and birch tar from various manufacturers. Methods. To assess the quality, the indicators and methods presented in GOST 31696-2012 "Cosmetic hygienic washing productions. General specifications", OFS.1.4.1.0041 "Medicinal shampoos", OFS.1.2.4.0002.18 "Microbiological purity", OFS.1.2.1.0004 "Ionometry", GOST 26878-86 "Shampoos for hair and wody. Method for determination of chloride content", GOST 29188.2-2014 "Perfumery and cosmetic production. Method for determination of pH value" were used. Results. Medicinal shampoo Ketoconazole VERTEX, medicinal shampoo Nizoral, anti-dandruff shampoo with ketoconazole Mirrolla, tar shampoo LIBREDERM, tar shampoo Psorilom, tar shampoo against dandruff Mirrolla, tar shampoo Nevsky Cosmetics were used as research objects. Their quality was assessed according to the following indicators: appearance, hydrogen pH, mass fraction of chlorides, foaming ability, viscosity, microbiological purity. At the same time, an amount of aerobic bacteria was found in sample No. 3, which does not exceed the permissible amount in the regulatory documentation. Conclusion. As a result of the conducted research, it was revealed that all the samples taken in the experiment comply with the requirements of GOST 31696-2012 "Cosmetic hygienic washing products. General technical conditions" and OFS.1.4.1.0041 "Medicinal shampoos".
Nikolai Konstantinovich Nikiforovsky was born on April 22, 1945, in the village of M. Gorodishche, Novgorod Oblast. A child of the post-war era, he experienced all the hardships and privations endured by Soviet citizens. His father, Konstantin Sergeyevich, a partisan and recipient of the Order of the Red Star, died young. From adolescence, his mother, Nina Ivanovna, raised him. Thanks to the upbringing instilled by his parents, his hard work, his extraordinary love of reading, his natural intelligence, and his tenacity, Nikolai Konstantinovich always excelled in everything he did. He graduated from high school in Khmelnik, Ukrainian SSR, with a gold medal, and was admitted to Smolensk State Medical Institute on his first attempt. He was an excellent student and was deeply involved in community service. For a long time, he headed the institute's Komsomol organization and was an active participant in the construction brigades movement in the Smolensk region. His community service did not hinder the future professor from pursuing excellent studies and research. After graduating with honors from the Smolensk State Medical Institute's Faculty of General Medicine in 1969, he continued his studies in clinical residency and then postgraduate studies in the Department of Obstetrics and Gynecology. He defended his candidate's dissertation in 1975 and his doctoral dissertation in 1991.
GRATITUDE TO A TEACHER FROM HIS STUDENTS IS A MEMORY THAT WARMS HEARTS.
May 31, 2025 marks the 80th anniversary of the birth of Alexander Nikolaevich Ivanyan, a leading scientist in the field of obstetrics and gynecology, a talented teacher, Honored Scientist of the Russian Federation, Honored Doctor of the Russian Federation, and head of the Department of Obstetrics and Gynecology at the Faculty of Continuing Professional Education at the Smolensk State Medical University (1994-2016).
EFFICACY OF PREVENTION OF POSTPARTUM HEMORRHAGE IN LOW-RISK PATIENTS UNDERGOING VAGINAL DELIVERY
Objective. To analyze prophylaxis of of postpartum haemorrhage in low-risk groups with natural delivery in a hospital of the 2nd and 3rd level of obstetric care. Methods. 203 cases of history of low-risk women delivered in 2024 at the 3rd (n = 118) and 2nd (n = 85) levels of obstetric care. Indicators were a drug for the prevention of bleeding, its dosage and method of administration, the volume of blood loss, a drop in hemoglobin after childbirth compared to pregnancy. Results. In 203 patients in the third period of labor was used: carbetocin - in 8 (3.9%), intravenous oxytocin 5 U - in 100 (49.3%), intramuscular oxytocin 10 U - in 95 (46.8%). Postpartum haemorrhage - 1.5%. The high efficacy of intramuscular oxytocin use was noted: no haemorrhage was recorded, the volume of blood loss and a decrease in hemoglobin after childbirth within acceptable values. Intravenous oxytocin administration was accompanied by a decrease in the volume of blood loss compared to intramuscular administration only in patients at level 3, but this was not confirmed by objective data: a decrease in hemoglobin of more than 20 g/l was recorded 2 times more often than with intramuscular administration (p<0.05). At the 2 level, the efficacy of the intramuscular and intravenous route of administration is the same (p>0.05). It was noted that the decrease in hemoglobin compared to antenatal in both hospitals was directly proportional to the volume of blood loss taken into account, but at the 3 level its volume is often underestimated. Conclusions. Prevention of postpartum haemorrhage in low-risk groups is carried out for all mothers. Oxytocin effectively prevents postpartum bleeding in low-risk patients. In a level 2 hospital, preference is given to technically simpler intramuscular injections of oxytocin; at level 3, intravenous administration is more often used. Objective control of hemoglobin demonstrates insufficiently objective accounting of blood loss at level 3.
FACTORS AFFECTING A WOMAN'S BODY'S READINESS FOR CHILDBIRTH
Objective. To study the factors that influence the response of the cervix to pre-induction of labor. Methods. The study included 116 pregnant women who underwent pre-induction of labor using a medical method. According to the level of cervical ripening (maturity), the participants were divided into two groups: the first group consisted of 63 women with a high response to pre-induction, and the comparison group included 53 women with delayed response, who required additional preparation before receiving a second dose of Mifepristone 24 hours later. Statistical analysis was performed using specialized software on a personal computer. Results. The study made it possible to study the signs in order to predict the rate of maturation of the cervix in response to pre-induction. According to the analysis of the data obtained, these include overweight in 8 (15.1%), obesity II grade - 11 (20.8%) patients with delayed response to pre-induction of labor, and a history of gynecological diseases that may be cervical ectopia - 34 (64.2%), endometriosis - 6 (11.3%), uterine fibroids - 13 (24.5%). The effectiveness of cervical preparation is influenced, among other things, by the parity of labor, anemia, chronic placental insufficiency. Conclusion. The analysis of the factors influencing the maturity of the cervix makes it possible to identify women with insufficient biological readiness for delivery and more accurately predict the effectiveness of subsequent induction of labor. Taking into account the identified factors and integrating the data obtained into clinical practice can be used to justify the duration of prenatal hospitalization and the implementation of targeted measures to prepare the woman's body for childbirth.
THE ROLE OF THYROID HORMONES IN THE MANIFESTATION OF HYPERTENSIVE DISORDERS DURING PREGNANCY IN PATIENTS WITH EUTHYROIDISM
Objective. To analyze the influence of thyroid hormones on the manifestation of hypertensive disorders during pregnancy in women with euthyroidism. Methods. Prospective cohort study including 459 observations. 39 pregnant women with hypertensive disorders: gestational arterial hypertension (n=25) and preeclampsia (n=14). Control group - 420 women with normal blood pressure. The analysis of the relationship of gestational hypertensive disorders with the levels of thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) adjusted for body mass index (BMI) and gestational weight gain (GWG) was performed. Results. Compared with the control, the average FT4 values were lower in pregnant women with hypertensive disorders: 10.7±1.7 pmol/l versus 9.9±1.4 pmol/l (p=0.01). The average FT3 level, on the contrary, was higher in the hypertensive disorders group - 5.0±1.1 pmol/l (p=0.046). The level of FT4, FT3, pregravid BMI, and GWG were statistically significant for predicting the development of hypertensive disorders during pregnancy. The model with the following output parameters was obtained: R2N=0.142, AIC=247.3, χ2=29.6, df=454, p<0.001. Statistically significant predictors of hypertensive disorders development were FT4 (OR 0.713, 95% CI: 0.55-0.924, p=0.011), FT3 (OR 1.534, 95% CI: 1.09-2.157, p=0.014) adjusted for GWG and BMI. With FT4 increase by 1 pmol/l, the chance of hypertensive disorders development during pregnancy decreased by 1.4 times, with free T3 increase by 1 pmol/l, it increased by 1.5 times. Conclusion. Free T4 and free T3 levels adjusted for pregravid BMI and GWG statistically significantly affect the development of hypertensive disorders during pregnancy. The probability of hypertensive disorders development increases with FT3 growth and decreases with FT4 increase. No association was found between TSH levels and hypertensive disorders during pregnancy.
TOXIC FORM OF PRIMARY PELVIC PERITONITIS IN A 5-YEAR-OLD GIRL
Objective. To present a description of one’s own clinical observation of a toxic form of primary pelvic peritonitis in a 5-year-old girl. Methods. An analysis of information obtained during clinical observation of a case of toxic form of primary pelvic peritonitis in a 5-year-old girl was conducted. Results. A 5-year-old girl in serious condition was admitted to the pediatric surgical department 6 hours after the onset of abdominal pain with peritonitis clinical picture. After preoperative preparation, diagnostic laparoscopy was performed and characteristic signs of primary pelvic peritonitis were found in the absence of destructive processes as a cause of secondary peritonitis. Antibacterial and detoxifying therapy in the first two days of the postoperative period led to obvious positive dynamics. The girl was discharged in satisfactory condition on the 8th day of the postoperative period with recommendations for outpatient observation by a pediatric gynecologist. Conclusion. In young girls with abdominal pain, there may be difficulties in differential diagnosis between acute appendicitis and its complications and primary pelvic peritonitis. Only diagnostic laparoscopy allows to clarify the diagnosis and choose the optimal treatment tactics
A CASE REPORT WITH A HETEROTOPIC PREGNANCY WITH CLINICAL OUTCOME
In this article provided description of a rare patology in obstetric and gynecological practice: spontaneous heterotopic pregnancy, in which case uterine and tubal pregnancies were developing at the same time. This is an urgent condition which is dangerous both for a woman and a fetus developing in the uterus. Heterotopic pregnancy has difficulties in diagnosis, at that transvaginal ultrasound has a leading value in it (in diagnosis). Also this condition requires emergency surgical care. However surgical intervention in early gestation, when the uterine pregnancy is prolonged, is a risk factor for complicated course of pregnancy. In this article described the features of diagnosis of heterotopic pregnancy, management tactics for such a patient with a desired uterine pregnancy and its outcome.