Vrach

The article is devoted to modern aspects of classification, epidemiology, pathogenesis, diagnostics, treatment and rehabilitation of background and precancerous diseases of the vulva and vagina. Particular attention is paid to stratification of intraepithelial neoplasia by HPV status, the role of immunohistochemical markers (p16, p53) and molecular genetic characteristics in prognostic assessment. Current data on clinical manifestations and diagnostic approaches, including non-invasive methods, reflective confocal microscopy are presented. Modern therapeutic strategies are summarized with an analysis of the effectiveness of imiquimod, photodynamic therapy, CO₂ laser and surgical interventions. Approaches to multidisciplinary rehabilitation are described, including the use of vaginal dilators, pelvic floor physiotherapy, psychosexual support and telemedicine technologies. The emphasis is on the need for an interdisciplinary and personalized approach to the management of this category of patients in order to improve the quality of life and prevent malignancy.

Children who born with a functional single ventricle undergo a series of surgical interventions at an early age, leading to the formation of Fontan circulation. Fontan circulation can lead to various disorders of pulmonary blood flow, depending on the specific heart defect, the volume of surgical interventions, the development of complications in the postoperative period, etc. Fontan circulation during the first years of life can lead to significant changes in pulmonary blood flow, which can affect long-term lung function. Also, functional changes in the lungs can also cause persistent circulatory disorders. Understanding the cardiopulmonary interactions along with improved recognition and treatment of pulmonary abnormalities may improve the long-term outcomes in this patient population.

Hair, like the skin and the human body as a whole, is subject to aging processes, which can be roughly divided into 2 aspects: aging of the hair shaft and aging of the hair follicle. There are currently no drugs for the targeted treatment of graying hair with proven effectiveness, and their development is the subject of scientific research. As for the treatment of age-related hair changes, it includes specific pharmacological therapies for hair loss, such as topical application of minoxidil and inhibition of 5-alpha reductase, as well as correction of age-related general health problems affecting the condition of the hair, such as: diseases of the gastrointestinal tract with impaired absorption of nutrients necessary for hair fiber disorders, endocrine diseases, psychological disorders related to substance abuse, and polymorbidity. In addition to using external remedies, to prevent alopecia, strengthen the hair follicle and hair structure, it is of great importance to supply the body with nutrients that ensure the health of the skin and its appendages. There is every reason to consider modern Russian developments Osteomed and Osteo-Vit D₃ as rich sources of such substances, which is the subject of our article.

The urgency of the problem is due to the need to implement the current clinical guidelines, as well as modern approaches to the treatment and prevention of bronchial asthma (BA), proposed by the GINA (Global Strategy for Asthma Management and Prevention) expert committee into the practice of physicians. There are many offers of training courses available on the Internet, which often do not give the expected results. This study presents the results of a two-stage testing of participants in the advanced training cycle (37 physicians of therapeutic profile from the Republic of Mari El) using research questionnaires within the ASSA-IV multicenter project «ASSA» («Assessment of senior medical students in the field of bronchial asthma ») to assess the baseline level of knowledge on the etiology, pathogenesis, diagnosis, and pharmacotherapy of BA. Descriptive statistics methods were used, and group comparisons were conducted using the Wilcoxon test. The proportion of correct answers of responses was 64.2 % (95% CI: 60.8–67.6%) in the first stage and 89.6% (95% CI: 85.6–93.1%) in the second stage. The Wilcoxon criterion for difference in mean was 664.5, which was statistically highly significant (p<0.001). The median value increased from 67% (Q1–Q3: 57–71%) to 90% (Q1–Q3: 8.5–100%). The greatest progress in average level of the proportion of correct answers values was observed in questions related to the etiology of BA (+31.6%; p<0.001 – question 1), BA pharmacotherapy (+59.5%; p<0.001 – question 14; +46%; p<0.001 – question 17; +67.6%; p<0.001 – question 18; +50%; p<0.001 – question 19). The findings confirm the necessity for physicians to regularly complete continuing medical education courses, prioritizing state-accredited educational institutions.

Arterial hypertension is a multifactorial disease, the progression of which is caused by several pathogenetic links, including activation of the renin-angiotensin-aldosterone system, endothelial dysfunction, and structural changes in the vascular wall of the arteries with increasing stiffness. Against the background of high blood pressure, target organs (heart, blood vessels, brain, kidneys, and retina) are affected, and as a result, associated clinical conditions develop, including atherosclerotic vascular damage, vascular changes in brain matter with the development of cognitive deficits, coronary heart disease, and various types of cardiac arrhythmias. The main objective of hypertension treatment is to prescribe therapy to achieve the target blood pressure level and protect the target organs. Also, in addition to prescribing effective antihypertensive medications, an important aspect of patient treatment is a personalized approach, taking into account concomitant pathology and the specific daily blood pressure profile of each patient to maximize possible reduction of cardiovascular risk and improve prognosis. This publication provides examples of personalization of antihypertensive therapy based on the use of the new drug Edarbi AM, which is a set of tablets in a calendar blister and includes, in addition to the blocker of the renin-angiotensin-aldosterone system azilsartan medoxomil, a scored tablet of amlodipine, which allows individualizing strategies for lowering blood pressure depending on each specific clinical situation.

Purpose. To study the clinical, immunological markers of the risk of developing occupational asthma (OA) under the influence of sensitizing substances.

Material and methods. The study was attended by 170 patients with various OA phenotypes, the control group was 50 conditionally healthy people. External respiratory function, levels of intraleukins-1β, -4, -6, -8, -10, -17, tumor necrosis factor-α, vascular endothelial growth factor, monocyte chemotactic protein-1, interferon-γ, and total immunoglobulin E were studied in the study groups. Genotyping by polymerase chain reaction was also performed.

Results. Features of clinical and immunological manifestations were established in allergic and non-allergic OA phenotypes, as well as phenotypes of the combined course of OA with a occupational chronic obstructive pulmonary disease and metabolic syndrome. Genetic risk markers of OA were revealed in the conditions of the effects of sensitizing substances (polymorphic variants of the RS1837253 TSLP gene).

Conclusion. The identified clinical, immunological and genotypic features for various OA phenotypes, the installed profiles of OA genotypes can help in early diagnosis, prognosis, prevention and pharmacotherapy of OA.

Purpose. To study the indicators of intestinal microbiots, the characteristics of neutrophilic granulocytes of peripheral blood and markers of systemic inflammation in patients with political studies.

Material and methods. The study was attended by 36 patients with political studies. The composition of the intestinal microbiots was analyzed by the 16s RRNK sequencing method, the correlation by the criterion of the syllaben was studied depending on the type of intestinal microorganisms and the content of neutrophilic granulocytes of peripheral blood, the polynomial dependence of the amount of neutrophilic myelocytes and segmented neutrophils on the size of C-reactive squirrel, the level Protrombin index and concentration of fibrinogen.

Results. Reliable correlation relationships between the content of granulocytic sprout cells and representatives of the types of microbial intestinal flora were identified. It was established that the number of types of microorganisms, reliably interconnected with the level of granulocytes, decreases with an increase in cell maturity. The relationship between markers of systemic inflammation and the degree of maturity of granulocytes was revealed.

Objective. To assess the effectiveness of a comprehensive physiotherapeutic intervention (calcium-phosphorus electrophoresis and interferential therapy) in adolescents with Osgood–Schlatter disease using the KOOS and SF-36 questionnaires.

Materials and methods. Ninety adolescents diagnosed with Osgood–Schlatter disease were divided into three groups: control (physical therapy), comparison (physical therapy + electrophoresis), and main (physical therapy + electrophoresis + interferential therapy). KOOS and SF-36 were used to assess dynamics before treatment, after the course, and 12 months later. Statistical analysis included Student's t-test, Mann–Whitney U test, and Wilcoxon test.

Results. The main group showed statistically significant improvement across all KOOS and SF-36 domains. The most notable changes were observed in the KOOS subscale “sports and recreation” and the SF-36 domains “vitality,” “physical functioning,” and “pain.” The comparison group showed moderate improvement; the control group showed minimal change. Improvements were maintained at 12 months.

Conclusion. The proposed combination of physiotherapeutic methods is effective for the rehabilitation of adolescents with Osgood–Schlatter disease and provides stable recovery of function and quality of life.

37 women with metabolically healthy abdominal obesity were examined, in whom the association of hypoestrogenemia with psychological changes was revealed. It has been established that the natural vitamin and mineral complex Eromax effectively affects the psychological state of the subjects. This innovative complex was created on the basis of many years of experience, has a diverse effect on women, allows them to safely normalize hormonal levels, neutralizes clinical manifestations, increases libido, has a positive effect on biological age, activates metabolism, contributing to the burning of excess fat. All components of the drug are physiologically close to the human body and do not interfere with the natural processes occurring in it. The drug Eromax is highly effective, has a fairly wide range of effects, and has a harmonizing effect on the body.

In a rapidly changing biosphere, the formation of a new system of human relations with the surrounding and the inner world occurs, which contributes to the development of noosphere and anthropogenic disharmony. There was a transition in the idea of the essence of somatic diseases from the organ and tissue level, as a consequence of disorders of the regulatory role of the central nervous, endocrine and immune systems, to the molecular level, where the pathology, first of all, will be determined by low -molecular primary metabolites. It is known that the deficiency of these primary metabolites occurs in all periods of life due to their insufficient intake with water, food or low level of their formation in the digestive organs.

There is a need for the effective prevention of various diseases, especially at the initial stage of their formation, as evidenced by the results of various studies devoted to the study of the role of endoecology and microbiota, water and nutrition, the antioxidant system, connective tissue, etc. Regulation of such processes requires the development of fundamentally new ideas about the essence of diseases, their prevention and treatment, as well as the allocation of an individual nozological unit.

Post-COVID syndrome has become a serious challenge for modern medicine, which healthcare will have to deal with in the coming decades. Patients after COVID-19 have an increase in body mass index, impaired carbohydrate metabolism, an increased risk of developing diabetes, progression of arterial hypertension and deterioration of kidney function. All this indicates the need for special attention to this group of patients, confirms the high social significance of the problem, emphasizes the need to develop comprehensive rehabilitation methods. This article reviews the literature on the problem of the consequences of COVID-19, identify laboratory predictors of the development of complications, as well as the availability of existing rehabilitation methods for patients after COVID-19.