Vol 32, No 7 (2021)

The progressive spread of the COVID-19 pandemic has required the urgent development of temporary clinical recommendations for the treatment of patients, as well as algorithms for hospitalization, and protocols for laboratory and clinical examinations. In addition, the important health care tasks are to implement organizational measures aimed at mitigating the spread of the infection, such as the introduction of quarantine measures, a mask regime, vaccination, and the standardization of testing methods for coronavirus infection. The purpose of this review is to consider the existing methods and algorithms for the implementation of the above measures. The paper considers the temporary clinical recommendations of the Ministry of Health of Russia for the prevention, containment, diagnosis, and treatment of the novel coronavirus infection, as well as the published studies of testing methods for COVID-19, the results of clinical trials of drugs used in its treatment, and independent reviews of some of the currently presented vaccines. Based on the described methods and approaches, conclusions are drawn about the inconsistency of the effectiveness of various treatment approaches, hospitalization algorithms, and organizational measures.

The paper is devoted to one of the most common occupational diseases, such as occupational asthma (OA) that occurs under industrial and agricultural production conditions when exposed to high- and low-molecular-weight compounds. It presents the main chemical and biological factors that are etiological factors of OA, as well as the main professions that are susceptible to this disease. The paper formulates the basic principles of the diagnosis of OA, the principles of its treatment, prevention, and examination of the association between disease and occupation, and professional suitability.

Objective: to develop a method for early non-invasive diagnosis of insulin resistance (IR) in pediatric practice. Subjects and methods. The investigation involved 1,939 children and adolescents who were divided into 2 age strata: under 10 years (n=625) and 10 years and older (n=1314). Each examinee underwent a set of clinical and metabolic studies, which included anthropometric measurements, by calculating the body mass index standard deviation score, bioimpedancometry with the determination of the main indicators of the body composition. In a random sample of 1859 examinees, serum insulin and glucose levels were determined, by estimating the homeostasis model assessment index of IR (HOMA-IR), C-peptide, leptin, and lipid spectrum. A correlation analysis was carried out to search for relationships between the studied bioimpedancometric parameters and metabolic status. ROC analysis was used to calculate the threshold visceral fat area values associated with a high risk for IR. Results. The statistical analysis revealed the threshold values of visceral fat area for bioimpedancometry, which were associated with the risk of IR. The obtained procedure had the sensitivity and specificity, which were comparable to those of the HOME index. Conclusion. Application of bioimpedancometry as a screening method for identifying a risk group among children and adolescents with different body weights will be able to implement timely therapeutic and preventive measures.

The mechanisms of development of jetlag in athletes are described. There are offered solutions for prevention of maladaptation in the directions of nutritive and pharmacological correction.

The paper presents the first experience in the surgical treatment of pulmonary tuberculosis (PT) in 19 (14 and 5) patients who had the novel coronavirus infection (NCI) in the pre- and postoperative periods, respectively). A comparative analysis was carried out in 11 patients with newly diagnosed PT who had been receiving anti-tuberculosis therapy (ATT) for 3-12 months and had experienced mild and moderate NCI before surgery and in 16 similar patients who did not have NCI. In patients with new-onset PT who had been receiving ATT for no more than 2 months, the high activity of tuberculosis inflammation in both groups was associated with the progression of tuberculosis and correlated with the detection of multiple or extensively drug resistant Mycobacterium tuberculosis (MDR/XDR MBT) in the surgical material. Both groups showed no differences in the duration of surgery, the amount of intraoperative blood loss, the duration and volume of exudation, the postoperative leakiness of the operated lung, and the total duration of drainage. The results of a morphological study of the surgical material point to the fact the histological pattern of caseous necrotic foci and the structural and functional state of their surrounding lung parenchyma suggests in most cases that the inflammatory process exhibits a low or moderate activity that is equally pronounced in both observation groups and independent of NCI experienced during ATT. The high activity of the process is characteristic of patients with an exacerbation of chronic tuberculosis, among whom MDR/XDR MBT was detected in the surgical material. There was no reactivation of the tuberculosis process in patients who continuously received ATT and successfully underwent surgical interventions for disseminated tuberculosis, in those who fell ill with COVID-19 in the late postoperative period. Thus, NCI is not a significant risk factor for the progression of the tuberculosis process in patients receiving ATT.

Inserting a flexible bronchoscope into the tracheobronchial tree involves the use of natural entrance gates: the nasal cavity (a nasal approach) and the oral cavity (an oral approach). The paper is devoted to the comparative analysis of the advantages and disadvantages of both approaches, which is to decide which access should be considered a priority. Material and methods. The investigators analyzed the advantages and disadvantages of using natural approaches during 5000 (100%) bronchoscopies and also estimated the frequency of painful sensations, retching (before anesthesia of the vocal folds), the possibility of using routine techniques for respiratory protection of bronchoscopy, as well as the frequency of early termination of bronchoscopy due to subjective intolerance in the study patient. For statistical assessment of the findings, the x2 test was used for two independent samples. Results and discussion. Transnasal and oral approaches were applied to perform 4562 (91.24%) and 438 (8.76%) bronchoscopies, respectively. A bronchoscope was inserted using the oblique direction in 755 (15.1%) patients undergoing the transnasal access. In 1300 (26%) patients undergoing the transnasal approach, nose pain sensations occurred, which went away in the absolute majority (1246 [24.92%]) of cases as the distal end of the bronchoscope was advanced into the nasopharynx. With the oral access, nausea or retching was significantly more common, as well as forced early termination of bronchoscopy; during which the differences reached the level for statistical significance. When applying the oral access, it was impossible to use this option of respiratory protection of bronchoscopy as a bronchological version of the non-return mask system. Conclusion. The transnasal approach is preferred. The oral approach should only be used if it is impossible to apply the transnasal access.

The paper describes a clinical case of treatment for an old right proximal femur fracture in a young female patient. In the patient, the immunomodulator thymalin, human immunoglobulin, and the antiseptic sodium hypochlorite were prescribed in the early postoperative period for prevention of infectious complications and for fast-track recovery. Due to the correct choice of an osteosynthe-sis procedure and to the optimization of the early postoperative period, the patient was on crutches on day 2 after surgery; primary intention wound healing occurred. The patient was discharged on day 7 to continue outpatient treatment.

Methylprednisolone aceponate (MPA) is the latest glucocorticosteroid molecule developed for topical use, having advantageous ratio of safety and efficacy. Peculiarity of MPA is its biotransformation after the application when primary MPA is transformed into more active metabolite methylprednisolone 17-propionate (17-MPP). This ensue the definition of metabolic profile - cutaneous concentration of 17-MPP after the application and MPA/17-MPP ratio (metabolic index). After the patent expiration appeared generic MPA drugs which didn’t pass through the full cycle of clinical trials. Metabolic profile of these generics and its equivalence to the original product is unknown. In the frames of this research the detection of MPA and its active metabolite 17-MPP after the application to the skin of laboratory animals (mini-pigs) was performed via HPLC-MS at several time-points. It was elicited that maximum 17-MPP concentration corresponds to maximum concentration of MPA, thus reflecting the correlation between cutaneous concentration of major metabolite and MPA local transformation. The absolute maximum of 17-MPP concentration and metabolic index was observed for the original drug Advantan® cream 0.1%, overwhelming same parameters for generic cream. This may be the result of differences in vehicles. The elicited metabolic profile differences potentially can question the equivalence of the original drug and generics.