Vol 32, No 1 (2021)

Acute respiratory viral diseases, including coronavirus disease, cause the progression of pre-existing chronic non-infectious diseases, including cardiovascular diseases (CVD) and type 2 diabetes mellitus (DM). The emergence of life-threatening complications against the background of a new coronavirus infection makes it necessary to study the features of the course of cardiovascular pathology and type 2 diabetes mellitus in conditions of this pathology. The regularities of the course of CVD and DM, as well as the development of complications in patients with COVID-19, are currently not completely established. The article provides an overview of the literature on the features of the course of cardiovascular pathology and type 2 diabetes mellitus in patients with COVID-19. The issue of the possibility of using drug therapy in patients with cardiovascular diseases, type 2 diabetes mellitus and COVID-19 is being discussed.

The article contains information about the epidemiology of arterial hypertension and its pathogenesis. Attention is paid to the method of correct measurement of blood pressure, factors that determine its variability. Gender features of arterial hypertension and various variants of the course of the disease are considered. The necessity of lifestyle modification and correction of risk factors (obesity, tobacco Smoking, alcohol abuse, etc.) was noted.

Epithelial ovarian cancer is the fifth most common cause of death in women in developed countries. The 5-year survival rate is 92% for a localized process and 29% for patients with advanced disease with peritoneal metastases. The standard treatment for epithelial ovarian cancer is primary cytoreduction followed by platinum-based chemotherapy. When it is impossible, neoadjuvant chemotherapy is performed. Purpose of the study. Comparative evaluation of MRI and MSCT in identifying peritoneal distant spread in OC with determination of the most informative method for predicting suboptimal cytoreduction. Materials and methods. The study is based on the analysis of visual diagnostic results and surgical treatment of 46 women with OC. Before primary cytoreduction, all patients underwent mp-MRI (22) and MSCT (27). The local distribution and the presence of secondary spread were evaluated. For each method the diagnostic information for predicting suboptimal cytoreduction were analyzed and ROC AUC analysis was performed. Results. In 15.2% (7) of cases, stage IIIa / b was established, in 52.2% (24) - IIIc and in 32.6% (15) - IVstage of the disease (FIGO). High grade serous carcinoma was observed in 91.3% (42), and low grade - in 8.7% (4). The sensitivity, specificity and accuracy in determining secondary spread for MSCT were 0.65, 0.96, and 0.85, for MRI - 0.85, 0.89 and 0.87. The positive and negative predictive value of MSCT is 0.91 and 0.79, MRI is 0.91 and 0.87. Complete cytoreduction was performed in 34 (73.9%) cases, optimal - in 7 (15.2%), non-optimal - in 5 (10.9%) cases (including 2 with vital indications). The area under curve for MRI in predicting suboptimal cytoreduction by the sum of points ranged from 0.81 (according to ESMO/ ESGO criteria) to 0.85. The ROC AUC based on the naive Bayesian classifier model was 0.88, which reflects the advantage of the weighted estimate of predictors based on their significance over the score Conclusions. MRI is superior to MSCT in the diagnostic informativeness of determining secondary spread of ovarian cancer. MRI has higher sensitivity for determining tumor metastases at the level of the most significant localizations from the point of view of cytoreductive intervention according to ESMO / ESGO data. The scale for assessing the respectability on the diagnostic criteria developed was superior to the approach based on the ESMO / ESGO criteria in its predictive accuracy.

Studies of the efficacy of low-molecular-weight heparins (LMWH) used in patients with a history of placenta-related pregnancy complications (PRPC) and the impact of this therapy on perinatal and long-term child development outcomes are presented by small cohort studies that are rather heterogeneous and do not answer the question of whether LMWH therapy is necessary at the pregravid stage. Objective. To evaluate the impact of pregravid preparation using LMWH in women with a history of PRPC on pregnancy course and outcomes and perinatal and long-term child development outcomes. Subjects and methods. The investigation enrolled 89 patients. According to the time of LMWH therapy initiation, the patients were divided into 3 groups: 1) 29 patients who initiated LMWH therapy at the pregravid stage; 2) 30 patients who started this therapy in the first trimester of pregnancy; 3) 30 patients who did this when they developed complications. The effect of the start of therapy on the incidence of PRPC, the course of the early neonatal period, and long-term child development outcomes was evaluated. Results. Combination therapy using LMWH in patients with a history of PRPC leads to a decrease in the frequency of these complications. The efficiency of the therapy depends on the time of drug administration: pregravid preparation is most effective and makes it possible to reduce the frequency and severity of PRPC, perinatal morbidity and mortality rates, and infant morbidity during the first year of life. The therapy that is initiated when the complications manifest is ineffective. Conclusion. Pregravid preparation using LMWH improves perinatal outcomes in patients with a history of PRPC.

Quality of life (QOL) was studied in 176 hypertensive women in the late fertile period with normal and reduced estradiol levels. The 36-Item Short Form Health Quality Survey was used. QOL was established to be significantly worsened in the hypertensive women in the late fertile period with estrogen deficiency compared with those in the same period with the preserved level of this sex hormone (р<0.05).

Odontogenic maxillary sinusitis is a common desease in the practice of maxillofacial surgeon and otorhinolaryngologist. At the same time, despite the improvement of diagnostic and treatment methods, the development of endoscopic technologies, choosing the optimal surgical technique for the treatment of this group of patients remains open. An additional complication is that in a number of patients in this group, dental implantation and surgical preparation for it (sinus-lifting) are included in the plan of dental rehabilitation, which requires the most sparing effect on the maxillary sinus. We have reviewed the most common methods of surgical treatment of odontogenic maxillary sinusitis. Fundamentals. Currently, due to the development of modern technologies, endoscopically assisted sinusotomy using various surgical approaches and their combinations is widely used. At the same time, the method of radical sinusotomy gradually loses its relevance due to the high risk of postoperative complications and serious (compared to endoscopic methods) surgical trauma. Conclusions. The use of endoscopic technologies in the surgical treatment of patients with odontogenic maxillary sinusitis provides a low traumatic operation and a shorter period of rehabilitation. For treatment planning and choice of surgical access required to conduct the computer tomography of the paranasal sinuses.

In recent years, the results of a number of studies on the problem of preterm birth have been published. It supposed that the rate of preterm birth should have reduced. Despite this, infection factors still contribute significantly to the structure of the causes of preterm birth. The aim of our study was to determine the role of infection in the structure of premature birth causes. A retrospective analysis of the course of pregnancy, delivery, complications in children at a level 1 unit was carried out in 276 patients with a gestational age of 22.0 to 34.6 weeks. Special attention was paid to various methods of infection diagnosis and its influence on the mother and fetus. Upon admission to the hospital, all patients underwent an assessment of the flora of the vagina and cervical canal by the bacterioscopic and cultural method, also by the method of polymerase chain reaction (qualitative PCR). To identify the role of infection in the genesis of extremely preterm birth in 196 (71.0%) children from 22.0 to 27.8 weeks, the bacterial spectrum of the flora was studied (sampling of material from the pharynx, anus; blood culture), a morphological study of the placentas was carried out. In preterm labor complicated by preterm premature rupture of membranes, a high rate (88.7%) of intrauterine infection and the presence of signs of inflammation (92.3%) in fetuses was revealed during post mortem examination. Analyzing the infection factor in newborns, in 81.6% opportunistic (58.8%) and pathogenic (41.2%) flora was detected. At the same time, only 36.0% showed a correspondence between the identified flora in mothers and children. In the absence of pathological flora and clinical symptoms of infection in the mothers 22.6% of children were born with intrauterine infection. It was noted that among the patients with the onset of preterm labor, in most of the results (91.2%), there was no lactobacilli domination that heads antimicrobial protection, while normally in the vaginal microbiota their number should reach up to 80.0%. It was shown that in order to objectify the infection factor in the genesis of preterm labor, it is necessary to introduce a new method for identifying the specific representatives of normo- and opportunistic vaginal biota - polymerase chain reaction (with real-time detection). Along with antibiotics, probiotics should be included in the treatment of preterm labor.

Ageism has a negative impact on human health. It is a form of human discrimination. At the same time, anti-aging is developing, which is gradually becoming a paradigm of clinical medicine and health care, aimed at maintaining good functionality at any age in the context of the concept of healthy aging.

When reforming public health, only its structural part often undergoes changes, the technological and functional parts do not receive enough attention, as a consequence the reforms do not give the expected effect. The forensic medical service can serve as an experimental base for testing innovations in the organization of public health without patient harm in healthcare facilities. Systems for the forensic medical service have been developed, which can be introduced into the practice of different units of a multidisciplinary hospital after easy adaptation to specific conditions.