Vrach

Modern technologies for treating children with oncological and oncohematological diseases have significantly increased survival. However, oncological diseases remain one of the significant causes of childhood mortality. In some cases, fatal outcomes and irreversible disability can be prevented by early diagnosis and, accordingly, timely treatment, which is impossible without non-invasive visualization of critical conditions. Life-threatening oncological conditions of the chest cavity can be primary due to the localization and spread of the tumor itself, or secondary (compression of organs and vessels, infection, complications of chemo- and radiotherapy). Visualization of the chest organs is necessary for the diagnosis of structural oncological conditions (diffuse or focal changes in the lungs, embolism, superior vena cava syndrome, cardiac tamponade). The authors presented the indications and possibilities of ultrasound and radiological diagnostics of primary malignant neoplasms in childhood and their life-threatening complications, emphasizing the need for immediate treatment of the patient.

Endometrial pathologies, including polyps, hyperplasia, and cancer, are a significant problem in gynecological practice. Despite advances in diagnostics, the choice of the optimal method remains a subject of debate. This article provides a detailed analysis of modern imaging methods and their role in differential diagnostics. Technical aspects, diagnostic accuracy (sensitivity, specificity), clinical limitations, cost-effectiveness, and prospects for technology development are considered. Based on systematized data from 180 studies, an algorithm for choosing a method depending on the clinical scenario is proposed.

The article provides general information about iron deficiency anemia in women of reproductive age, outlines the main causes and syndromes of the disease, briefly describes routine and modern laboratory diagnostic methods and provides principles of ferrotherapy with the inclusion of modern ferropreparations.

A clinical case of a patient with a mixed form of cystic fibrosis with bronchopulmonary and gastrointestinal manifestations is presented. Despite the screening of newborns, as well as the active use of available diagnostic sweat tests and genetic analysis, the diagnosis cannot always be accurately confirmed, the problem of diagnosing cystic fibrosis both at the manifestation of the disease and at the subsequent stages of its development remains relevant.

Diagnosis of cystic fibrosis requires physicians to be alert to cystic fibrosis in pulmonary and intestinal disorders, to inform physicians of the diagnostic signs of cystic fibrosis, to adequately assess the clinical picture and internosological diagnosis, to be aware of possible false-negative and false-positive results when using a modern set of diagnostic tools. Diagnosis and treatment of cystic fibrosis are in the process of continuous improvement. Timely therapy, taking into account the origin of the syndrome, can significantly improve the patient's condition, increase the duration and quality of his life. Recent advances in the field of cystic fibrosis gene modification open up new avenues in the treatment of this disease.

Results of studying the main indicators of occupational morbidity in the Samara region, identifies their features and differences from similar indicators in the Russian Federation, and trends in their changes in the period from 2019 to 2023 is presented.

The analysis of the structure of occupational diseases, taking into account nosological forms, professions, according to the work of the Samara regional Center of Occupational Pathology. The features of the structure and dynamics of indicators of occupational morbidity of medical workers in the Samara region, including in the context of the pandemic of the new coronavirus infection Covid-19 in 2020 and 2021 and in the post-pandemic period, are determined. The need to improve the quality of preliminary and periodic medical examinations, preventive measures, and improve the examination of the connection of diseases with the profession is emphasized.

The article notes the insufficient effectiveness of dual antihypertensive therapy (Perindopril and Amlodipine) in relation to lipid and calcium homeostasis, as well as peripheral hemodynamics and vascular wall rigidity in women with grade 1–2 hypertension and low cardiovascular risk. The article assesses the effect of the natural osteoprotector Osteo-Vit D3 and the antioxidant Dihydroquercetin Plus on the main indicators of the lipid spectrum, phosphorus-calcium metabolism and structural and functional parameters of the vascular wall in women of reproductive age and during menopause suffering from hypertension. It is shown that the addition of these drugs to standard antihypertensive therapy contributes to a significant improvement in the lipid profile in both study groups: a decrease in total cholesterol, low-density lipoproteins and triglycerides. In groups of women of reproductive age, statistically significant decrease in calcium, increase in magnesium and vitamin D were established, in the subgroup taking only Osteo-Vit D₃ in addition to antihypertensive therapy - decrease in alkaline phosphatase level. In groups of women over 45 years old, similar dynamics were recorded in relation to vitamin D and magnesium, decrease in calcium level, increase in alkaline phosphatase was observed. In the subgroup taking Osteo-Vit D₃ and Dihydroquercetin Plus along with antihypertensive therapy, decrease in inorganic phosphorus was noted. Significant effect of Dihydroquercetin Plus on the structural and functional properties of blood vessels in women with arterial hypertension during menopause is emphasized. The authors suggest that the observed effects may be associated with the ability of the studied drugs to eliminate hormonal, metabolic and mineral imbalances and recommend their use for early prevention of cardiovascular diseases in women of reproductive age and for therapeutic purposes during menopause.

Objective. To study the significance of genetic and acquired thrombophilia factors in the development of thromboembolic complications (TEC) in patients with pelvic malignancies.

Materials and methods. A retrospective-prospective cohort study with a control group was conducted. It included 546 patients with malignant neoplasms of the pelvic organs, as well as a control group of 137 patients with benign tumors. The patients were divided into three groups: I (n=155) – patients with TEC; II (n=391) – patients without TEC; control group (n=137). Laboratory studies were performed to detect antiphospholipid antibodies (anti-β₂-glycoprotein (β₂GPI), anti-annexin V, and anti-prothrombin), and genetic tests using PCR were performed to detect FV Leiden, MTHFR C677T, prothrombin G20210A mutations, PAI-1 4G/5G and platelet glycoprotein polymorphisms (GPIIb/IIIa, GPIa/IIa, GPIb, and GP ADP).

Results. Group I was found to have a significantly higher frequency of antiphospholipid antibodies (aPL) circulation (55.8%) and genetic markers of thrombophilia: FV Leiden mutation (20,6%), homozygous MTHFR C677T (41,3%), PAI-1 gene polymorphism (28,4%) and platelet glycoprotein (44,5%). In group II, a moderate frequency of aPL circulation was observed: to β₂GPI (13,1%), prothrombin (7,8%) and annexin V (2,6%). The FV Leiden mutation was detected in 9,7% of patients, the homozygous form of the MTHFR C677T in 6,1%, the PAI-1 gene polymorphism in 9,7%, and platelet glycoprotein in 10,2%. In the control group: aPL to β₂GPI and annexin V were present in 2,6% of patients, the FV Leiden mutation – in 10,2%, the homozygous form of the MTHFR C677T – in 7,3%, the PAI-1 gene polymorphism – in 10.9% and platelet glycoprotein – in 8,8%.

Conclusion. The study confirmed the significant contribution of genetic and acquired thrombophilia to the development of thrombotic complications in patients with gynaecological cancer. The highest risk was observed in cases involving a combination of genetic mutations and aPL.

Objective. To identify the features of uterine hemodynamics in the patients with unexplained infertility and the patients with a history of miscarriage.

Material and methods. A total of 263 patients planning pregnancy were included in the study. The patients were divided into 3 groups: 108 women with unexplained infertility (infertility group), 116 patients with a history of miscarriage (miscarriage group) and 39 fertile women (control group). The patients underwent an ultrasound examination to assess uterine perfusion.

Results. The average value of the pulsatility index in the right and left uterine arteries >3.0 was detected in 25.9% of patients with infertility, in 16.4% of patients with a history of miscarriage, and in 7.7% of the control group (between the infertility and control groups p<0.05). Spiral arteries were not visualized in 13.9% of patients with infertility, in 10.3% of women with a history of miscarriage, and were detected in all fertile women (infertility group vs. control, p<0.05; miscarriage group vs. control, p<0.05).

Conclusion. In assessing the pregravid state of the endometrium, it is advisable to use the following indicators: visualization of spiral arteries and the average value of the pulsatility index in the right and left uterine arteries >3.0.

The current issue of improving prosthetic methods for patients with periodontal disease is discussed. Significant advantages of vertical tooth preparation (VTP) in combination with Osteomed Forte (Parafarm) at the stage of temporary prosthetics in patients have been identified in order to accelerate the formation and adaptation of soft tissues, as well as to increase the growth of keratinized gingiva.

The study conducted a comprehensive assessment of the clinical effectiveness of the VTP technique in combination with the use of Osteomed Forte in patients with periodontal disease at the stage of temporary prosthetics. The study involved 45 patients (23 men and 22 women) aged 23 to 65 years with periodontal disease requiring fixed prosthetics, divided into a main group (n=25) and a control group (n=20). The observation period was 2 months.

The features of clinical and radiological examination of patients were considered, and criteria for evaluating the effectiveness of treatment were determined. A detailed treatment protocol is presented, including the stages of preparation, temporary prosthetics, and the prescription of Osteomed Forte (Parafarm). Particular attention was paid to VTP and the manufacture of temporary structures in combination with Osteomed Forte (Parafarm).

Objective. To the evaluation of the therapeutic possibilities of using transcutaneous electrical neurostimulation in order to prevent the formation of sexual dysfunctions in men.

Materials and methods. 120 men under the age of 35, who are quoted as practically healthy, but are characterized by a decrease in the quality of sexual activity. Patients were evaluated for hormonal background and mental status, as well as neuromuscular and vascular parameters in the pelvis.

Results. In the first phase of work, the effectiveness of two “soft” complex drugs indicated for sexual dysfunctions was determined. The observed individuals were divided into groups in which, in addition to medications, placebo was used. The resulting insufficient effectiveness of this type of exposure determined the additional use of the transcutaneous electrical stimulation method. In this regard, treatment groups were identified, in which, in addition to the combined drug and reflex effects, a hardware placebo was used. In the case of combined stimulation, 65% of men noted an improvement in sexual activity, while with the use of placebo – 50%. In addition, according to the follow-up data, the proposed complex provided a reliably greater stability of the results achieved.

Conclusion. The confirmed effectiveness of the combined medicinal and reflex effects aimed at restoring the sexual activity of men can be explained by the summation and even potentiation of therapeutic mechanisms.