Vrach

The bicuspid aortic valve (AoV) (BAV) occurs in about 1% of the population, while the probability of its observation in first-degree relatives is 9-10%. Familial aortic aneurysm in BAV is inherited as an autosomal dominant disease with incomplete penetrance. BAV accompanies connective tissue dysplasia, congenital cardiovascular defects, aortic coarctation, Turner syndrome, etc., is frequently concurrent with cardiac arrhythmias, general somatic, and neuropsychiatric disorders. The basis of diagnosis is transthoracic echocardiography (EchoCG). If needed, transesophageal EchoCG, magnetic resonance imaging and/or computed tomography of the heart are performed. Persons with BAV, even without stenosis or valve insufficiency, are frequently recorded to have dilation of the ascending aorta and/or its root. Aortic dilation may occur many years after the detection of BAV, more often in valve insufficiency. Abnormal systolic blood flow through the BAV leads to regional aortic wall tension and promotes the development of aortopathy that is manifested as aortic aneurysm and dissection. Arthropathy develops in the presence of cystic media damage, activation of matrix metalloproteinases, and apoptosis. The aim of interdisciplinary management in patients with BAV is the prevention of circulatory disorders, the early detection of complications and the identification of a group of patients to be referred to cardiac surgeons. Taking into account the fact aortic aneurysm may develop late, therapeutic monitoring should be continued after surgical correction of valve abnormality. During a follow-up, BAV should be considered as a manifestation of the systemic process.

Advances in surgery make it possible to successfully treat seriously ill patients who are on prolonged artificial lung ventilation. As a result of a combination of ischemia, trauma and infection of the tracheal mucosa due to chronic inflammation, the normal structures of its wall are replaced by fibrous tissue, which is manifested by narrowing of the tracheal lumen with the development of progressive suffocation. Despite the studies conducted, the mechanism and timing of the formation of a chronic inflammatory reaction and a fibrous process in the affected area and peripheral bronchopulmonary structures in various variants of post-intubation tracheal complications are not sufficiently disclosed. One of the most important areas in tracheal surgery is ensuring the safety of operations in order to reduce the number of postoperative complications and mortality. This applies both to simultaneous radical operations and stage-by-stage interventions, as well as to new intra-light technologies. The advantage of cicatricial tracheal stenosis is the possibility of preserving the pathologically altered tracheal wall for the formation of the respiratory tract, unlike oncological practice. Further development of tracheal surgery directly depends on the introduction of preventive measures and analysis of adverse factors associated with an increased risk of complications. An integrated approach to the prevention, treatment and rehabilitation of patients with cicatricial tracheal stenosis allows us to develop personalized tactics aimed at improving the effectiveness of treatment and achieving full rehabilitation of each patient. We believe that the research conducted in this field of science is promising.

Cervical cancer (CC) is the fourth most common cancer among women in the world. In the Russian Federation, the incidence of cervical cancer is in second position in the structure of genital cancers. The WHO Global Strategy to Accelerate the Elimination of CC as a Public Health Problem recommends an integrated approach to prevention and control of CC that combines vaccination, screening and treatment. A review and analysis of modern data on this problem over the past decade is presented. Scaling up HPV vaccination, increasing the level of cervical screening and coverage of the female population, developed post-screening management and timely treatment of precancer will reduce the incidence and mortality associated with cervical cancer.

Certain successes have been achieved in the fight against tuberculosis (TB) in the Russian Federation in recent years. However, the current TB situation remains tense. A certain role in this has been played by the spread of nosological entities that also include diabetes mellitus (DM). The review presents data on the prevalence, the features of the course of TB and DM comorbidity, and the efficiency of its treatment.

Objective. To assess the effectiveness and safety of the combined medicine interferon alpha-2b + loratadine (Grippferon^® with loratadine, nasal ointment) for the prevention and treatment of acute respiratory viral infections (ARVI) in patients with year-round allergic rhinitis.

Materials and Methods. A total of 154 patients were included in the study and divided into four groups: group 1A patients (n=37) received the combined medicine interferon alpha-2b + loratadine (Grippferon^® with loratadine) 5 times a day for 7 days for the ARVI treatment; in group 2A (n=41) standard therapy was carried out in accordance with the clinical guidelines for the ARVI treatment in adult patients (2021). Group 1B (n=38) patients used the combined medicine interferon alpha-2b + loratadine once a day for 7 days for the ARVI prevention; in group 2B patients (n=38) ARVI prevention was not conducted. There were 75 (48.7%) men and 79 (51.3%) women, aged 22-45 years.

Results. During treatment with the combined medicine interferon alpha-2b + loratadine in group 1A patients there was a significant decrease in respiratory manifestations (such as nasal congestion, rhinorrhoea, sneezing) by comparing with group 2A patients. Rhinocytogram analysis results showed that the use of the combined medicine interferon alpha-2b + loratadine contributed to the reduction in the intensity and severity of inflammatory (leukocyte count) and allergic (eosinophils) responses. In group 1B patients, who received the medicine interferon alpha-2b + loratadine for the ARVI prevention, we noted that during three observation months 3 times less patients got acute respiratory infections by comparing with group 2B patients.

Conclusion. The received study results demonstrate that the use of topical medicine interferon alpha-2b + loratadine in patients with concomitant acute respiratory viral infections and year-round allergic rhinitis shortens the ARVI treatment period. The preventive use of the given medicine allows us to reduce the number of ARVI in patients with year-round allergic rhinitis.

The paper presents the results of studying the communicative patterns that have developed in everyday obstetric and gynecological practice, as well as the patients’ ideas about them.

Objective. To study the opinion of obstetric and gynecological patients on their communication with medical specialists.

Subjects and methods. A total of 975 patients who were on inpatient treatment in obstetric and gynecological clinics were surveyed.

Results. For older respondents, the absence of tattoos and piercings, as well as the presence of a badge, are important in the appearance of a physician. Almost half of the respondents consider that the physician should comfort an upset patient by giving him the opportunity to vent his negative emotions. To get information on medical topics, most patients use social media; 27.6% are not absolutely interested in social media. 20% of the patients have the impression that the physician talks with him irritably or in a "negative" form; 67% of the patients would like to participate in decision-making with the physician regarding their health.

Conclusion. In order to increase the satisfaction of patients with their interaction with medical specialists, the physicians need to improve their communication skills, pay attention to their image and appearance, and to show empathy when communicating with patients.

The use of removable and non-removable orthodontic equipment shifts the biochemical, microbiological, and immunological balance of the oral cavity, which contributes to the increase in the risk for tooth hard tissue carious lesions and for periodontal diseases.

Objective. To identify the relationship of the activity of the development of enamel demineralization on the initial level of hygiene in the patient and on the level of his oral fluid acidity.

Subjects and methods. The investigators evaluated the patient hygiene performance (PHP) index and the International Caries Detection and Assessment System (ICDAS) index and also measured the oral fluid pH in 6–12-year-old patients with a changeable occlusion who have undergone treatment with aligners. The patients were divided into 2 groups: a study group (n=25) who had received treatment with aligners and a control group (n=25) who had not received this treatment option.

Results. No statistically significant differences were found between the study and control groups in the probability of developing a carious lesion; however, the localization of enamel demineralization foci differed significantly in the groups, which needs further study.

Of all diseases of the musculoskeletal system, degenerative changes of the spinal column occupy the first place in frequency. Especially in recent years, cases of diagnosis of dystrophic changes in the vertebrae and intervertebral discs in children have become more frequent, which indicates the rejuvenation of this pathology, and, as a result, an increase in cases of disability of the young population.

The presence of congenital defects of the vertebral apparatus is important for the rate of progression of the disease. Such an innate feature is considered to be the Kimmerle anomaly. Several variants of the Kimmerle anomaly are known: 1) ossification is observed between the articular process of the atlas (C1) and its posterior arch; 2) the bone arch connects the articular process of the Atlas and its transverse process. Pathology can be unilateral or bilateral, and the bone arch may be complete or incomplete, then the bone bridge remains unclosed in the form of an arched outgrowth.

In the presence of connective tissue dysplasia at the same time, even in the most minimal manifestations, and Kimmerle anomaly, a more rapid development of denegerative changes of the cervical spine can be observed.

An analysis of Russian and foreign publications on the tactics of treating menopausal women with concomitant diseases of the cardiovascular system was carried out. The prospects for the use of drugs with phytoestrogens as an alternative therapy for menopausal manifestations are considered. The effectiveness and safety of the Russian drug Femoklim is evaluated in the context of providing a personalized approach to the treatment of patients in menopause, taking into account existing cardiovascular pathologies.

Scleroderma is an inflammatory disease that is evident as skin atrophy. The pathogenesis of scleroderma remains not completely understood. It is agreed that this disease arises from vascular changes, impaired fibroblast function, and immune dysfunction. The scientific literature also widely discusses an association between scleroderma and Borrelia infection. To date, there is no consensus regarding the mechanism of the influence of Lyme disease on the development of focal scleroderma. However, multiple cases of its occurrence after tick bites have been described.

The authors want to draw the attention of specialists to this problem, by presenting their own case from practice. A thorough history collection and examination of patients with focal scleroderma are necessary in order to detect Borrelia infection and, conversely, there is a need for the close monitoring of patients with Lyme disease for the timely initiation of therapy for focal scleroderma.

The article provides a detailed examination of the current role of digital health technologies (DHTs) in modern healthcare. Special attention is given to their impact on professional development of specialists, opportunities for integration into practice, and key issues related to patient data security. The benefits that DHTs can bring to the daily practice of dentists are analyzed, as well as the potential risks and challenges associated with their use. The article offers recommendations for the effective use of digital technologies, ensuring confidentiality and security of patient data, and emphasizes the importance of continuous education for professionals in the era of digitalization.