Vrach

In the 21st century, the attitude towards the diagnosis and treatment of hemorrhagic diathesis in pediatrics has changed significantly. Proper care and preventive measures remain the cornerstone of care for children with thrombocytopenia, thrombocytopathies and hemophilia. Timely diagnosis of thrombocytopenia requires knowledge of the clinical features of the disease. In addition to hormonal therapy, the arsenal of aids for idiopathic thrombocytopenic purpura has been thoroughly expanded, and the principles of treatment of chronic thrombocytopenic purpura have especially changed. The pathogenetic features of the correction of acquired and hereditary thrombocytopenia defects remain not entirely resolved. Innovations have certainly affected hemophilia. Thanks to advances in bioengineering technologies, unprecedented therapeutic progress has been achieved. Drugs with new mechanisms of action have appeared, based on restoring the formation of thrombin or simulating blood coagulation factor VIII. In addition to emicizumab, which is already approved for children with severe hemophilia A, other non-replacement drugs are being evaluated in clinical trials. Gene therapy drugs have been tested in adult patients. In this review, we provide updated information on the participation of nurses in the care and treatment of hemorrhagic diathesis in children, and the rehabilitation of patients with hemophilic arthropathy.

The article analyzes modern scientific research on bisphosphonate-associated osteonecrosis of the jaw (BONJ). It has been shown that a significant place in the etiology of BONJ is occupied by the features of the craniofacial region, as well as microbial infections, periodontal diseases in addition to tooth extraction, implant placement and other dental interventions. It has been revealed that a great importance in the pathogenesis of BONJ is attached to a change in cellular immunity, a negative effect on angiogenesis. In order to prevent BONJ, an integrated approach is proposed (a doctor prescribing treatment; a dentist; a periodontist and a dental hygienist) to the management of patients undergoing Bisphosphonates therapy, observing the time between taking Bisphosphonates and dental interventions, oral sanitation, patient education and raising awareness of doctors in the field of BONJ. Further clinical and basic scientific research is needed to gain a more complete understanding of the pathophysiology underlying BONJ and prevention methods.

Identifying characteristic changes in a comprehensive set of laboratory tests for the current infection can provide diagnostic and prognostic value. By analyzing this data, it is possible to develop prognostic models to determine treatment strategies.

Objective. To identify prognostic criteria for the development and outcomes of viral lung damage, using the example of a COVID-19, to stratify patient management in a hospital setting.

Material and methods. The study included 294 adult patients (aged 58.6±13.7 years; 39% male) hospitalized with lung damage caused by a COVID-19 in 2020. The assessment of disease severity and patient treatment was conducted in accordance with interim guidelines for the prevention, diagnosis, and treatment of the novel coronavirus infection. Based on outcomes, two groups were formed: Group 1 included 77 patients with fatal outcomes; Group 2 included 217 patients who recovered. To detect SARS-CoV-2 RNA, swab samples were analyzed using the polymerase chain reaction method.

Results. Based on the obtained data, a formula for predicting unfavorable outcomes was derived using clinical, anamnestic, and laboratory predictors through logit regression followed by logit transformation. The logit model identified eight of the most significant factors associated with a high risk of mortality in patients. Using these factors, a computer program was developed using HTML and JavaScript technologies.

Conclusion. To stratify patient management in cases of widespread viral diseases (using the COVID-19 pandemic as an example) upon hospital admission, the logit model can be employed to predict disease progression. In cases of high risk for unfavorable outcomes, it can guide treatment strategies, including the potential need for transfer to the intensive care unit.

Despite significant weight loss after bariatric surgery, some patients may develop gastroesophageal reflux disease (GERD) or experience its exacerbation if it existed prior to the surgery. The impact of different bariatric procedures on reflux has been studied in several scientific works, but no universally accepted approach to selecting surgical techniques considering GERD currently exists. The diverse clinical and diagnostic manifestations of GERD complicate its classification. The severity of reflux can be quantified by pharmacotherapy costs, including those for proton pump inhibitors (PPIs).

Objective. The objective of this study was to analyze changes in pharmacotherapy costs in patients with GERD diagnosed before bariatric surgery for morbid obesity, depending on the type of surgical procedure performed.

Materials and methods. Data were analyzed from 70 patients who received PPIs for GERD before surgery. Changes in pharmacotherapy costs were assessed for two types of bariatric surgery: sleeve gastrectomy (SG) in 32 patients and Roux-en-Y gastric bypass (RYGB) in 38 patients.

Results. In the SG group, the median pharmacotherapy cost over six months before surgery was 4944 rubles, decreasing to 1807 rubles 18–24 months post-surgery (p=0.00076). In the RYGB group, costs decreased from 3803 rubles pre-surgery to 533 rubles post-surgery (p<0.00001).

Conclusion. The reduction in GERD therapy costs after SG suggests a positive effect of weight loss and obesity treatment on GERD. However, SG may sometimes lead to significant reflux exacerbation. A more pronounced anti-reflux effect, reflected in a greater reduction in pharmacotherapy costs, was observed in the RYGB group, making this procedure the preferred option for patients with both morbid obesity and GERD.

Objective. To evaluate the effectiveness of mucolytic therapy and its impact on the quality of life of children with primary ciliary dyskinesia (PCD).

Materials and methods. Analysis of discharge epicrisis of 60 children with PCD who were twice in the department of Pulmonology at the Veltischev Institute from 2023 to 2024.

Results. In children with regular therapy, there was a decrease in inflammatory markers in the blood: leukocytes from 8.1±1.28 to 6.8±1.0 thousand/ml, neutrophils from 4.3±1.1 to 3.3±0.56 thousand/ml (p<0.05). Children who had not previously received basic therapy, after initiation of daily mucolytic treatment, showed a significant increase in all indicators of external respiratory function (p<0.05). Also, in these children, the residual lung volume decreased from 196.0±47.8% to 167.0±37.8% (р<0.05). Conversely, in children with irregular therapy, residual lung volume increased from 148.0±28.3% to 172.0±37.0% (р<0.05). In children with regular therapy, the average quality of life was 73.20±6.66%, compared with 63.20±8.08% in children without basic treatment (p<0.05). Also, in these children, the indicators of the physical and psychological components of health were higher by 10% compared with children whose mucolytic therapy was insufficient: 64.0±8.73% and 74.0±7.1%, 62.0±8.32 and 72.0±7.03%, respectively (p<0.05).

Conclusion. Daily mucolytic therapy is vital to improve the condition and quality of life of children with PCD.

The main indications for the use of surgical treatment methods are destructive forms of the tuberculosis process with drug resistance of the pathogen, including bilateral ones. However, the use of resection methods of treatment may be accompanied by a large amount of loss of lung tissue and a violation of the functional parameters of the lungs in the future. A possible solution to this problem can be the use of methods of collapse therapy (artificial pneumoperitoneum) and valvular bronchoblocation as preoperative preparation in patients with pulmonary tuberculosis, including those with drug resistance of the pathogen.

A clinical case is given, which demonstrates the high effectiveness of using these methods in the framework of preoperative preparation in a patient with a widespread tuberculosis process and drug resistance of the pathogen. The proposed integrated approach contributed to reducing the volume of surgical intervention and preventing the development of functional disorders in the postoperative period.

Endovascular surgery is widely used for emergency indications and, in some cases, is an non-alternative method of treatment. Four cases of endovascular interventions in patients with disorders of the blood coagulation system and the resulting treatment difficulties were considered.

The long process of the incus is most often subject to destructive changes in chronic purulent otitis media. In recent years, otolaryngologists have begun to use glass ionomer cement to reconstruct the ossicular chain.

Objective. To evaluate the efficiency of glass ionomer cement in ossiculoplasty.

Material and methods. 11 patients with chronic purulent otitis media were treated and underwent reconstruction of the long process of the incus using glass ionomer cement.

Results. Analysis of the study results showed that the use of glass ionomer cement in ossiculoplasty allows to eliminate the defect of the long process of the incus and diastasis of the incudostapedial articulation with a good anatomical and functional result.

Purpose. To study the effect of metabolic syndrome (MS) on the fertility of women of reproductive age using standard clinical diagnostic methods.

Material and methods. 242 women of reproductive age took part in the prospective open-open clinical and epidemiological study, of which 120 detected MS. All patients conducted a standard clinical and instrumental-laboratory examination to assess the state of health before the planned pregnancy. The results were obtained using descriptive statistics.

Results. The results indicate the influence of even MS 1st degree on a decrease in fertility in women.

Conclusion. Thus, even with MS of the 1st degree, women of reproductive age need to observe from doctors of obstetrician-gynecologists and doctors of other specialties in order to timely diagnose and prevent complications to maintain reproductive health and increase the birth rate of the population.

The article presents the results of 24-hour Holter ECG monitoring in 33 patients with arterial hypertension and abdominal obesity. When analyzing arrhythmias, it was found that both supraventricular and ventricular extrasystoles are often registered in hypertension and obesity. Cardioton is a natural cardioprotector of the cardiovascular system; it strengthens the heart muscle by improving its oxygen supply, has antiarrhythmic, cardiotonic, and hypotensive effects. It is recommended for disorders of the cardiovascular system, with increased physical exertion. After using the drug Cardioton, there is a positive trend towards a decrease in the number of extrasystoles, normalization of heart rate and improvement of general well-being and quality of life of patients.