Vrach

In global evidence-based cardiovascular medicine practice, age 75 years or older is often considered the onset of old age, while age 85 years or older is often used to denote very old age. More than a quarter of individuals aged 75 years and older have confirmed ischemic heart disease (IHD). The main predictors of clinically significant coronary atherosclerosis in the elderly are arterial hypertension, dyslipidemia, type 2 diabetes mellitus, chronic kidney disease, and tobacco smoking. Elderly patients with IHD are characterized by atypical clinical manifestations of coronary insufficiency. Active search for IHD in asymptomatic elderly patients is not recommended. Imaging studies, including ischemic stress tests, should be supported by the presence of angina or its equivalents. Multimodal diagnostic approaches aimed at identifying indications for invasive techniques to eliminate the underlying cause of coronary insufficiency are considered useful not only in young but also in elderly patients.

This paper presents an analysis of the current literature on occupational diseases of the blood system caused by the effects of harmful industrial factors of a chemical nature. A number of harmful production factors (benzene and its homologues, lead, mercury, acrylates, etc.) can cause various changes in the blood system, which in the advanced stage of occupational disease can be leading and determine their outcome. Knowledge about the mechanisms of the formation of occupational hemopathies and their early clinical manifestations will contribute to the timely diagnosis of the disease and the choice of optimal tactics of therapeutic and preventive measures for this contingent of workers.

This article examines age-related aspects of the diagnosis and staging of chronic kidney disease (CKD), as well as the etiology, epidemiology, and clinical features of the disease. It provides a detailed review of dietary therapy options: recommended intake levels for protein, energy, macronutrients, and micronutrients during pre-dialysis stages and during dialysis; issues related to infant feeding; correction of protein-energy malnutrition; and the use of specialized formulas. The article presents variations of Diet No. 5, daily nutrient requirements, and sample menus for children of different ages. It emphasizes the need to individualize nutrition based on the stage of CKD, nutritional status, and comorbid conditions (obesity, diabetes mellitus).

This article analyzes the key challenges facing the provision of palliative care (PPC) in the Russian Federation at the present time. It examines the regulatory framework, statistical indicators of the service’s development, and the main barriers (related to staffing, organization, medication, and regional disparities). Based on a synthesis of official statistics, regulatory documents, and scientific publications, disparities between public demand and actual coverage have been identified. Particular attention is paid to restrictions on access to potent analgesics, the shortage of trained specialists, and the weak integration of PPC into primary health care. Recommendations for improving the system are proposed, including strengthening interagency cooperation, expanding training programs, and developing mobile care services. The conclusion is drawn that a comprehensive modernization of the service is necessary to improve the quality of life for terminally ill patients.

Psoriasis is a chronic immune-mediated skin disease frequently associated with comorbid hepatobiliary disorders, including non-alcoholic fatty liver disease (NAFLD), drug-induced hepatitis, and primary biliary cholangitis (PBC). Dysregulation of the bile acid pool has been documented in psoriasis patients, providing a rationale for investigating choleretics and cholekinetics as adjuvant options.

Objective. To systematically evaluate clinical and experimental evidence for the efficacy of choleretics and cholekinetics in psoriasis and characterise mechanisms underlying their anti-inflammatory and immunomodulatory effects.

Materials and methods. A PRISMA-2020 systematic search was performed in PubMed, PubMed Central, Embase, eLibrary, and CyberLeninka (2015–2026); seminal mechanistic studies from 2002 onwards were also included.

Results. Fifty-eight publications were included, covering eight classes of choleretic agents: ursodeoxycholic acid (UDCA), dehydrocholic acid, secondary bile acids (LCA, DCA, 3-oxo-LCA), hymecromone (4-methylumbelliferone), silymarin, berberine, glycyrrhizin/glycyrrhetinic acid, and artichoke extract. Mechanisms include FXR and TGR5 activation, inhibition of IL-17A, NF-κB and p38 MAPK, suppression of hyaluronic acid synthesis, and restoration of intestinal barrier function.

Conclusions. Choleretics and cholekinetics show promise as adjuvant therapy in psoriasis with hepatobiliary comorbidity; UDCA has the strongest evidence base. Large-scale RCTs are required.

The ultimate goal of treating burns and wounds is to restore the lost skin layer. Self-healing is possible only in the case of superficial injuries, while deep wounds require skin grafting. At all stages, local conservative treatment plays a key role, creating conditions for regeneration within the optimal timeframe, since it is impossible to accelerate cell division. The fundamental conditions for managing wounds are to keep the process within its natural biological course and to eliminate negative factors: necrosis, infection, dehydration, or excessive hydration.

In combustiology, two main approaches are used: open (dressing-free) and closed (dressing-based), each of which is implemented using either a dry or a moist method. A special place in the local treatment of burns is occupied by atraumatic mesh dressings, primarily of domestic production, which contain an antiseptic component (chlorhexidine, furagin, or povidone-iodine). An important feature of the Silcobint series of dressings is the painlessness and atraumatic nature of the dressings, provided that they are necessarily combined with a secondary absorbent dressing. The widespread use of dressings at the clinical bases of the Department of Thermal Injuries at the Russian Medical Academy of Continuous Professional Education of the Ministry of Health of Russia in 2024–2026 confirmed the effectiveness of these dressings in patients with various types of burns.

Purpose. To establish the characteristics of the quantitative and qualitative composition of platelet-rich mass for the formation of a platelet-rich plasma (PRP) therapy protocol in patients with metabolic gonarthrosis.

Materials and methods. To confirm the diagnosis of gonarthrosis, clinical, laboratory, and orthopedic examinations were carried out, assessing the function of the affected joints. The study involved 60 patients (37 women and 23 men) aged 42 to 64, who were divided into two groups of 30 people each. The first group had grade 2 knee osteoarthritis according to N.S. Kasinskaya, with grade 1–2 pain syndrome and the presence of hyperuricemia. The second group had knee osteoarthritis of the 2nd degree according to N.S. Kasinskaya, with pain syndrome of the 1^st-2^nd degree without hyperuricemia. All patients underwent intraarticular injection of PRP. Before injection into the joint, it was mixed with a low molecular weight fraction of 1.6% hyaluronic acid. A week later, a similar procedure was performed with a preliminary assessment of the patient's condition according to the WOMAC index (pain assessment scale, stiffness assessment scale, physical functioning assessment scale). Finally, an analysis of the clinical results in both groups after double administration of PRP with an interval of three weeks. The observation period for the patients was 3 months; the study is ongoing.

Results. The obtained results of the WOMAC index on all three scales indicate the effectiveness of intraarticular injection of PRP mixed with a low molecular weight fraction of hyaluronic acid in patients of both groups, but the indicators in patients with hyperuricemia were less pronounced.

Conclusion. The study confirmed that intra-articular administration of this combination is a safe and at the same time effective method of treating gonarthrosis, promotes rapid relief of pain, reduces stiffness and improves joint function. The use of this method of treatment is becoming a promising area in the work of orthopaedists.

Objective. To assess the effect of topical application of colloidal silver on the speed and quality of postoperative wound healing in children after gynecological surgery.

Materials and methods. A prospective randomized controlled trial was conducted involving 60 girls aged 12 to 17 years who underwent gynecological surgeries. Patients were randomized into two groups: the main group (standard care + colloidal silver) and the control group (standard care only). Wound healing time, the incidence of postoperative infections (ASEPSIS scale, levels of IL-1, TNF-α, MMP), pain intensity (VAS), cosmetic outcome (Vancouver Scar Scale; VSS), and parental satisfaction with treatment were assessed.

Results. The use of colloidal silver significantly reduces wound healing time, lowers the incidence of postoperative infections, reduces pain intensity, and improves cosmetic outcomes. Serum IL-1 and TNF-α levels were significantly decreased in the colloidal silver group compared to the control group. Parental satisfaction with treatment was also higher in the colloidal silver group.

Conclusions. Colloidal silver is an effective and safe agent for accelerating the healing of postoperative wounds in children undergoing gynecological surgery. It can be recommended as an additional agent to improve postoperative care, as it reduces the number of infectious complications, reduces pain, and improves cosmetic outcomes.

Objective. To study the characteristics of professional burnout among physicians specializing in internal medicine and general surgery at a specialized inpatient hospital.

Materials and methods. The study participants were divided into 7 groups based on their specialty: Group 1 (n=52) – gastroenterologists; Group 2 (n=58) – cardiologists; Group 3 (n=48) – medical oncologists; Group 4 (n=71) – general surgeons; Group 5 (n=30) – cardiac surgeons; Group 6 (n=65) – surgical oncologists; Group 7 (n=75; control group) – professionals in engineering, technical, and economic fields (healthy). The level of professional burnout was assessed using V.V. Boiko’s methodology for diagnosing professional burnout. Each component of “burnout” was diagnosed based on four criteria, which form the corresponding scales (V.V. Boiko, 2008, 2015).

Results. The professional activities of physicians in therapeutic and surgical specialties are associated with exposure to chronic occupational stress, leading to the development of occupational burnout.

Conclusion. The data obtained indicate the need to identify risk factors, assess the level of occupational burnout among specialists in the surgical and medical fields, and implement specialized rehabilitation measures for medical professionals using relaxation techniques, art therapy, and professional adaptation programs; physiotherapy techniques: electrosleep and reflexology, spa treatment, visits to psychotherapy clinics, and psychopharmacological medications.

Objective. To evaluate the diagnostic accuracy of N-terminal pro-B-type natriuretic peptide (NT-proBNP) for detecting low left ventricular ejection fraction (LVEF) (≤40%) in hospitalized patients with chronic heart failure (CHF) and to determine the optimal diagnostic threshold.

Material and methods. A single-center retrospective study included 62 CHF patients (67.7% male; median age 71.5 years) admitted to the cardiology department of Yakutsk Republican Clinical Hospital. ROC analysis with bootstrap validation and multiple linear regression were performed.

Results. Median NT-proBNP increased with declining LVEF: 376, 1320, and 2483 pg/mL for preserved, mildly reduced, and reduced LVEF (p < 0.001). AUC was 0.730 (95% CI: 0.597–0.862). The optimal threshold of ≥869 pg/mL yielded sensitivity 72.7%, specificity 65.0%, and negative predictive value 81.3%. Independent predictors of log(NT-proBNP) were low LVEF (β = 1.358; p = 0.002) and creatinine (β = 0.010; p = 0.017).

Conclusion. NT-proBNP demonstrates moderate diagnostic accuracy for detecting low LVEF. Its high negative predictive value supports its use as a stratification tool for reduced ejection fraction; echocardiographic confirmation remains essential.