Vol 31, No 12 (2020)

The article is devoted to the current field of public health - medical prevention of noncommunicable diseases (NCDS). Based on the analysis of scientific literature, the author describes the risk factors in their relationship and mutual influence, provides an interpretation of the stages of medical prevention with examples of their implementation. The paper reflects the strategies of medical prevention and its levels, as well as the forms and methods of work on the prevention of diseases. The importance of timely screening of non-communicable diseases was emphasized. The author notes the personal role of the doctor in the implementation of effective medical prevention.

Craniocerebral traumas (CCT) account for 40% in the pattern of traumatic injuries. Brain damage is the leading cause of death and disability in the populations under 40 years of age. According to the clinical classification of brain contusions (BC) in Russia, which evaluates the clinical course of CCT and neurological status, they are divided into mild, moderate and severe types. The authors also identify an anatomical classification, such as foci of local posttraumatic ischemia or those of type I contusion, foci of contusion or those of type II contusion, intracerebral hematomas or foci of type III contusion. In the clinical course of BC, one type of contusion turns into another, i.e. its development is a dynamic process. An increase in the BC focus over time is called its progression, while 35-50% of hemorrhagic foci are prone to develop. The paper describes predictors for the progression of contusion foci and also considers in detail the treatment of BC, namely medical and surgical treatments. Neuroprotection occupies a special place in the treatment of BC.

Patients with COVID-19 report lack of vitality. This condition is caused by severe hypoxia. Tissue hypoxia is affected by a novel class of drugs called partial fatty acid oxidation (p-FOX) inhibitors; its international nonproprietary name is meldonium. Objective: to evaluate the efficiency of using Meldonium Organika capsules 500 mg in relieving asthenic syndrome in post-COVID-19 patients. Subjects and methods. A total of 128 patients (59 men and 69 women) aged 51 to 54 years were followed up; 52.3% of them complained of chronic, persistent, severe fatigue. A study group included 30 patients with asthenic syndrome lasting at least 2 months; in addition to the standard therapy, the patients took an oral 500-mg Meldonium Organika capsule twice daily for 3 months according to the management protocol for post-COVID-19 patients. The comparison group included patients (n=30) who received stable therapy according to the protocol of a patient’s mindset who underwent COVID-19 with concomitant somatic and neurological pathology that complicates the study; the presence of a history of severe allergic reactions and autoimmune diseases in patients, viral forms of hepetitis (including the carrier of viruses), as well as acute infectious diseases during the 4 weeks preceding blood sampling. Results and discussion. The clinical neurological picture was determined by the involvement of the central mechanisms that regulate the somatosensory system in the pathological process. Before treatment, the patients in the study group had MFI-20 scores of 15.3±0.2; those in the comparison group had 15.2±0.2 scores. After the end of treatment, the study group showed a significant improvement in 26 (86.7%) patients; the mean MFI-20 score was 9.7±1.6 (p<0.01); the comparison group had improvements only in 2 (6.7%) patients; the mean score was 14.6±1.2 (p<0.05). Thirty days after the end of therapy, the mean MFI-20 score was 10.7±0.8 in the study group (p<0.01); in the comparison group, the scores did not change from the baseline ones (15.1±0.2) (p<0.05). Conclusion. The multilevel nature of the nervous system lesion in COVID-19 has been revealed, which requires the choice of individual therapy. The investigation shows that it is expedient to incorporate 500-mg Meldonium Organika capsules for the therapy of asthenic syndrome in post-COVID-19 patients.

Cutaneous melanoma is a rather rare malignant tumor that arises from epidermal melanocytes. The tumor is noted for late diagnosis and high mortality, which necessitates focusing efforts to identify and excise melanoma precursors - dysplastic nevi. These nevi are characterized by the presence of lentiginous melanocytic dysplasia (LMD), which is associated with their ability to transform into melanoma. Material and methods. A total of 178 pigmented masses with a clinical diagnosis of progressive dysplastic nevus (grade 3 LMD) were excised in the Central Polyclinic of the Literary Fund in 2009 to January 2020. The patients were referred to an oncologist by therapists, dermatologists, and other specialists of the polyclinic. Results. Histological examination revealed 133 dysplastic nevi. Twenty-eight (15.7%) patients were found to have grade 3 LMD; 17 (9.5%) patients had early melanoma that developed in 7 cases in the presence of LMD. Conclusion. The aim of this study is to draw the attention of primary care physicians to the problem of progressive dysplastic nevi (grade 3 LMD), the early detection and excision of which will ultimately contribute to the prevention and early diagnosis of melanoma and, as a consequence, reduce mortality from this disease.

The article deals with the study of prevalence of extraintestinal manifestations in young adults with celiac disease after the transition to an adult polyclinic network. During the study the features of clinical manifestations are revealed and the degree of their intensity depending on the patients adherence to a gluten-free diet is studied. The results of therapeutic interventions aimed at treating the manifestations of the underlying disease are presented. The peculiarities of patients follow-up after their transition to adult polyclinic network are discussed. Moreover, the article concerns the preventive measures focused on the treatment of the celiac disease extraintestinal manifestations.

The paper analyzes the results of different treatment approaches to active knee joint drainage after arthroplasty in 65 patients. The patients were divided into 4 groups: drainage tubes of different diameters were used in 3 groups, no drainage was performed in one group. There is evidence for the expediency of using active drainage with one thick tube and bellows. There was no significant difference between 250- and 500-ml bellows. In the absence of drainage (the differences were statistically significant), there was a smaller decrease in hemoglobin levels on days 3 and 5 postsurgery with an increase in the time of wound adhesion and knee joint swelling.

The paper describes the experience with the oral fibrinolytic thrombovazim in the medical treatment of acute ascending varicothrombophlebitis of the lower extremities when using a direct oral anticoagulant, diosmin preparations, and elastic leg compression. The investigation enrolled 104 patients with a confirmed diagnosis of acute ascending varicothrombophlebitis. The patients were divided into 2 groups similar with respect to sex, age, and degree and level of saphenous vein thrombosis: 1) 50 patients received only basic therapy according to clinical practice guidelines (a comparison group); 2) 54 patients had basic therapy in combination with a fibrinolytic drug (thrombovazim), 800IU, twice daily for 20 days (a study group). The paper presents comparative results after 3 and 6 months of the start of treatment in both groups, analyzes the time course of changes in venous bed recanalization and that in reducing the clinical manifestations of the disease, and evaluates the safety of this treatment method.

Overlap syndrome is characterized by the presence of diagnostic criteria for two or more diseases. The term is used in rheumatology, endocrinology, pulmonology, and psychiatry. The aim of this investigation was to demonstrate the feasibility of using the term «overlap syndrome» in neurological practice, by using an example of a clinical case of a patient with HIV-associated lymphoma and cerebral toxoplasmosis.

The paper provides a brief review of the literature on the epidemiology and pathogenesis of multiple sclerosis (MS). It shows the social significance of this pathology. Disability related to MS for the period 2014-2019 was analyzed from the results of examination at the Main Sociomedical Expertise Bureau in the Yamalo-Nenets Autonomous Okrug, Ministry of Labor of Russia. The contingent of MS-related disability people mainly included young individuals of working age, the urban population, and patients with persistent static-and-dynamic, visual, urinary excretory, or mental dysfunctions. Sociomedical examinations in these citizens more frequently showed their limited ability for self-service, movement, behavioral control, and work activities. Groups 2 and 3 disability prevailed. In most cases, MS leads to disability within the first 5 years of the disease. Their initial examinations more commonly identify Group 3 disability. Relapsing-remitting MS predominates among the examined.