Vol 32, No 4 (2021)

The article deals with the problem of alcohol abuse from the perspective of medical prevention. The relevance of this problem is due to the wide spread of 283 million people. in a world with high mortality and negative social consequences. Modern classification of disorders in accordance with ICD-11 is given, pathophysiological mechanisms of alcoholism formation are considered, risk groups and negative consequences of chronic alcohol use are described. Measures to prevent alcoholism, including those implemented at the state level, are described.

The paper deals with the embryology, anatomy, and physiology of the respiratory system, which are considered in the context of clinical significance for the practical activities of neonatal anesthesiologists and resuscitators. It gives the definition, classification, and degree of respiratory failure (RF). The pathogenetic predictors and perinatal risk factors for the progression of and the features of the clinical picture of RF have been studied in extremely premature babies. The paper shows the neonatal diagnostic criteria for and the clinical assessment of the severity of respiratory distress syndrome. It discusses the most common clinical and etiological variants of RF: newborn respiratory distress syndrome and congenital pneumonia, which are characteristic for extremely premature babies in the early neonatal period.

The impact of combination therapy with glycine and lisinopril (diroton) on quality of life (QOL) was studied in 77 patients with hypertension and reduced estradiol levels. The 36-Item Short Form Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS) were used to assess QOL. After combination therapy with glycine and lisinopril, the QOL in patients with hypertension and estrogen deficiency improved significantly (p<0.05) in all the parameters of the SF-36. The treatment resulted in a significant (p<0.05) decrease in anxiety disorders, such as irritability, sleep disorders, and concentration difficulties. Combination therapy with glycine and lisinopril was well tolerated by all the patients.

Objective. To estimate the value of a subjective factor in interpreting stress echocardiography (stress EchoCG). Subjects and methods. A total of 112 patients preliminarily diagnosed with coronary heart disease (CHD) were examined. All the patients underwent exercise stress echocardiography and a quantitative assay to assess local kinetic disorders using 2D strain. The investigation was analyzed by different expert groups. Results. When the results of stress echocardiography were assessed by two experts, the sensitivity, specificity, positive and negative prognostic value, as well as the accuracy of the method increased. When the findings were assessed using 2D strain, the sensitivity, specificity, and overall accuracy of the investigation results proved to be lower than those in the visual assessment of the test. Conclusion. The investigation is recommended to be conducted by two experts, by basing not only on echocardiography. The quantitative method for assessing local kinetic disorders using 2D strain does not exceed the results of the traditional visual assessment of stress EchoCG data.

Objective. To evaluate platelet function and the efficiency of antiplatelet therapy, by using clinical data and spontaneous platelet aggregation indicators in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Subjects and methods. The study involved 154 people, including 104 patients with ACS (82.7% men; 17.3% women; mean age, 60.7±10.4 years), who underwent emergency coronary intervention. The patients received dual antiplatelet therapy. Spontaneous and induced platelet aggregations were studied by the turbidimetric method. The ACS patients (n=104) were divided into 3 groups: acute ST-elevation myocardial infarction (MI) (STEMI), non-ST-elevation MI (NSTEMI), and unstable angina (UA). A control group included 50 healthy individuals (14% men; 86% women; mean age, 41.7±14.9 years), who did not take antiplatelet drugs. Results and discussion. During 12 months, spontaneous platelet aggregation decreased by 5-20% in patients with STEMI, by 30-40% in those with NSTEMI, and 14-21% in those with UA. The indicators of spontaneous and induced platelet aggregation did not depend on the presence or absence of the loading dose of an antiplatelet drug at the prehospital stage or on age and gender. This indicator significantly reduced within 24-48 hours after disease onset; i.e. the decrease in platelet aggregation began no earlier than 24 hours after disease onset. The indicators of platelet aggregation did not differ in ACS patients on admission and in the control group (p>0.05). The ACS patients (n=15) who did not receive the loading dose of antiplatelet agents at the prehospital stage were found to have higher induced platelet aggregation rates than the patients in the control group. In patients with platelet hyperaggregation, ticagrelor was more effective in reducing spontaneous platelet aggregation, while in those with normal and low aggregation of platelets, ticagrelor and clopidogrel had the same effect on their function. In inpatients with ACS, spontaneous platelet aggregation decreased by 23.9% during antiplatelet therapy (p=0.0001); by 36.8% when using the inducer adenosine diphosphate (ADP) at a concentration of 0.1 mmol/ml (p=0.0001); by 62.5% when applying ADP at that of 1.0 mmol/ml (p=0.001); by 47.2% when employing ADP at that of 5.0 mmol/ml (p=0.001). Platelet aggregation returned to the baseline level in 80.3% of patients at 6 months and in 86.9% at 12 months. The patients with platelet hyperagregation developed cardiovascular events (UA, recurrent MI, stent thrombosis) developed in 100% of cases; 33% had normal aggregation and 14% had hypoaggregation.

The problem of rational, effective, and safe treatment for atopic dermatitis (AtD) is in the focus of practitioners’ close attention. The authors present their own experience with the currently available enterosorbent Alesorb gel in the combination therapy of adults with AtD.

Age is a reliable predictor of poor outcomes in acute coronary syndrome (ACS). In this particular meaning, the main risk factor in elderly patients - senile asthenia syndrome (SAS) or «frailty», is acquiring. The aim of this study is to develop a mathematical logistic regression model for other patients with acute coronary syndrome and to assess its quality in comparison with research tools commonly used for the comprehensive geriatric assessment of patients with ACS. Material and methods. To construct mathematical models of logistic regression, data on 300 patients with ACS were used. 50 (16.7%) patients were diagnosed with myocardial infarction with ST segment elevation, 126 (42.0%) patients had myocardial infarction without ST segment elevation, and 124 (41.3%) patients had unstable angina pectoris. Frailty was assessed using two scales: the Green frailty rating scale and the Fried frailty rating scale. In the course of the study, mathematical models of logistic regression were constructed using the «Enter» methods and step-by-step direct and reverse methods. Results. Indicators of sensitivity, specificity and accuracy in assessing the frailty of patients with ACS when using a model built using the reverse stepwise method, have maximum values and are respectively 86.3 (80.1; 90.7%), 90.8 (84.9; 94.5%) and 88.4 (86.0; 89.7%). With a decrease in the number of parameters measured in a patient from 7 to 4, the indices of sensitivity, specificity and accuracy are lower and amount to 81.3 (74.5; 86.5%), 87.2 (80.7; 91.8%), 84.1 (81.5; 85.7%). Conclusion. In the course of the study, three mathematical models of logistic regression were built, which allow assessing the fragility of patients with ACS, which can be used in an emergency, at the prehospital stage and after discharge from the hospital.