Vrach

Presents current information on community-acquired pneumonia in children, including the authors’ own experience. An analytical review of new data on the etiology and clinical features of community-acquired pneumonia was carried out. Trends over the previous 5 years – non-pharmacological interventions and changes in social behavior during the COVID-19 pandemic – influenced not only the spread of SARS-CoV-2, but also the seasonal circulation of a number of respiratory pathogens. The main directions of treatment and prevention are described, and modern approaches to the prescription of antibiotic therapy are discussed in detail. The need for regular monitoring of the etiology and clinical picture of community-acquired pneumonia in childhood, effective vaccination coverage against respiratory infections, and the development and improvement of accurate diagnostic methods is emphasized. Future research should focus on optimizing antibiotic use, comparing the effectiveness of different antibiotic treatment regimens, and determining the optimal dosage and duration of treatment.

The patient’s digital double is a dynamic computer model that includes medical and physiological characteristics of a particular patient, that is, in fact, a digital copy of a person. The patient’s medical data in dynamics are loaded into this model, and the conclusions based on the model can be used to correct therapy. Thus, an electronic medical card from a static storage turns into an interactive tool that is able to predict the development of the disease and a reaction to various medical interventions.

An important problem of diabetes mellitus is the high incidence of complications, one of which is diabetic foot syndrome, which occurs in 30-85% of patients with this disease and leads to early disability and premature mortality of patients of working age. Due to the presence of different pathogenetic mechanisms of development there is a need for further study of predictors and diagnostic markers of this syndrome, which will help in the future to develop individual therapy based on the identification of the affected pathogenetic link in the patient and improve the quality of life and life expectancy of patients, as well as reduce the social and economic damage caused by this disease to the state.

Objective. Comparative analysis of the therapeutic efficacy of the combined preparation of diosmin and hesperidin in two cohorts of patients with chronic venous insufficiency (CVI) stratified by body mass index.

Material and methods. A prospective clinically controlled study of the efficacy of therapy with the combination of diosmin and hesperidin in 104 patients with chronic venous diseases (C0-C3 according to CEAR) was carried out. The efficacy of pharmacotherapy was assessed by comparative analysis between the group of patients with excessive body weight and the group with normal anthropometric indices.

Results. After 8 weeks of treatment with the combination of diosmin and hesperidin a significant decrease in the severity of discomfort in the lower extremities, intensity of heaviness, leg pain and the feeling of leg oedema was observed (p<0,01). The effect of the therapy in both groups was a decrease in the volume of the lower leg and improvement of the CIVIQ-20 quality of life scores (p<0.01).

Conclusion. The obtained data indicate comparable high efficacy of the combination of diosmin and hesperidin for treatment of clinical manifestations of CVI in patients with both normal and overweight.

Objective. To conduct a comparative analysis of the impact of different anticoagulant therapy regimens on the dynamics of laboratory markers of the hemostasis system (D-dimer, thrombin-antithrombin complex [TAC], prothrombin fragments F1+2) and the frequency of thrombohemorrhagic complications in the perioperative period in patients with malignant neoplasms of the pelvic organs.

Materials and methods. A prospective, comparative, randomized, interventional study was conducted involving 964 patients with squamous cell carcinoma of the cervix, endometrial cancer, ovarian cancer, and squamous cell carcinoma of the vulva. All patients were subject to radical surgical treatment and were randomized into four groups depending on the anticoagulant therapy regimen: Groups I and II received low molecular weight heparin (LMWH) 10 and 1 day before surgery and then 10 days after surgery, respectively; Groups III and IV – only in the postoperative period (LMWH and unfractionated heparin, respectively). The comparison group (n=75) did not receive anticoagulant prophylaxis. To assess the activation of the coagulation cascade and fibrinolysis, quantitative methods for determining D-dimer, TAC complex, and F1+2 fragments were used. Statistical processing was performed using the Mann–Whitney criterion (p<0.05).

Results. In the study group, the incidence of deep vein thrombosis was 3.3–4.3%, pulmonary embolism – 1.1%, while in the comparison group these figures reached 13.3 and 6.7%, respectively (p<0.01). In groups I and II, no cases of moderate bleeding were recorded in the postoperative period. The most pronounced decrease in hemostasis markers (D-dimer, TAC, F1+2) was observed in group I, where LMWH was used 10 days before surgery. In the comparison group, on the contrary, persistent hypercoagulation with wave-like dynamics of markers and their significantly higher values throughout the postoperative observation period was revealed.

Conclusion. Preoperative administration of LMWH provides a significant reduction in the risk of thrombotic complications and promotes rapid normalization of hemostasis parameters while maintaining a high safety profile. The absence of anticoagulant prophylaxis is associated with pronounced activation of the coagulation system and a higher risk of deep vein thrombosis and pulmonary embolism in oncogynecological patients in the postoperative period.

Cri du chat syndrome (ICD-10: Q93.4, Lejeune syndrome) is a hereditary disease caused by the loss of part of the fifth chromosome. Despite the fact that Lejeune syndrome is not considered the most dangerous genetic disease, the general prognosis is unfavorable. Only 10% of children survive to the age of 10, 5% – to 18 years.

Taking into account that this pathology is extremely rare in the practice of a pediatrician, and there are isolated publications in the domestic literature, the authors present a clinical case with identified chromosomal pathology.

Perimenopausal osteoporosis is a disease with a decrease in bone mineral density and a high risk of fractures due to hormonal disorders. Special diagnostic methods and therapy that take into account the etiopathogenesis of the disease can reduce disability rates associated with OP among perimenopausal women. The article presents the results of the examination and treatment of 36 perimenopausal women with OP and reveals the potential for diagnosis, which makes it possible to evaluate the effectiveness of therapy. Osteomed drug has shown effectiveness in reducing and closing cavities in the trabecular sections of bones in patients with verified OP and androgen deficiency, and improvement of hormonal status in perimenopause has allowed to suspend the development of OP and even achieve its partial regression.

The article describes the work of the interdisciplinary rehabilitation team department of early medical rehabilitation of a multidisciplinary hospital on the example of rehabilitation care for a patient who underwent hip replacement surgery.

In elderly patients, a screening of functional ability should be carried out, since this cohort of patients especially needs preventive measures to prevent a decrease in functional ability in the conditions of primary health care. The article analyzes the connection of functionality with age -related vitality, the degree of independence, the course of diseases and other parameters. The im-portance of the ICOPE system into the national healthcare system is substantiated, and the signifi-cance of digital technologies in geriatrics is reflected.

Objective. To evaluate the parameters of the lipid peroxidation system (POL) and antioxidant protection system (AOP) in adolescents with recurrent headache syndrome (RH).

Materials and methods. 104 adolescents (boys and girls) aged 12–17 years were examined, of which 66 adolescents with RH (the main group) and 38 without RH (the comparison group). The presence of RH was verified by a screening questionnaire, the content of the indicators of the POL-AOР system was determined by spectrophotometric methods. The received data is processed in the program Statistica 12.

Results. Adolescents with RH had higher levels of malonic dialdehyde (MDA) in blood plasma and red blood cells; decreased activity of plasma and erythrocyte superoxide dismutase (SOD), and lower levels of protein in blood plasma. The presence of RH in adolescents is associated with a larger number of individuals characterized by high plasma and erythrocyte concentrations of MDA, low plasma and erythrocyte SOD activity, and low glutathione-S-transferase activity. The authors highlight the possibilities of correcting oxidative stress using antioxidants.

Conclusion. RH in adolescents is associated with a higher content of pro-oxidant – MDA in plasma and red blood cells, a lower activity of the antioxidant enzyme – SOD in plasma and red blood cells, which indicates a greater severity of oxidative stress in this contingent. The group with RH has a higher number of adolescents with the above-mentioned shifts in the gender-AGE system than among their peers without RH. It is advisable to prescribe antioxidants to correct the manifestations of oxidative stress in adolescents with RH.

The article describes the practice of using splint therapy in patients with pathology of the temporomandibular joint, selected after a thorough comprehensive diagnosis. After 4 months of splint therapy, all participants reported positive dynamics, however, in the long-term period, several participants reported resumption of pain (women over 55 years old, with daily speech loads for 6-7 hours, due to professional activity). It is likely that when selecting a therapeutic strategy, it is necessary to take into account gender, age, and characteristics of professional activity.