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Vol 33, No 5 (2022)

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Topical Subject

Possibilities and prospects of epigenetic rehabilitation in patients with external genital endometriosis

Begovich E., Solopova A.G., Khlopkova S.V., Vlaslna A.Y., Kuznetsova V.V.


Epigenetics is a modern promising field that studies the activity of genes in response to environmental and lifestyle factors. Knowledge of epigenetic mechanisms, starting from intrauterine development, can expand the possibilities of timely treatment of external genital endometriosis, early prevention of relapses and carcinogenesis. The present review considers and systematizes data on the use of epigenetic mechanisms in rehabilitation based on the analysis of modern scientific medical literature, both domestic and foreign. This study showed that epigenetic mechanisms significantly affect the formation of external genital endometriosis and endometriosis-associated ovarian cancer. Standard therapy in combination with epigenetic rehabilitation will lead to a decrease in the recurrence of the disease and stabilization of the achieved results. Thus, it is crucially important to develop pathogenetically substantiated comprehensive rehabilitation schemes that will provide a personalized approach, timely prevention, prognosis and treatment of external genital endometriosis.
Vrach. 2022;33(5):5-8
pages 5-8 views

Structured programs for the management of patients with non-alcoholic fatty liver disease in the work of a general practitioner

Skvortsov V.V., Ustinova M.N.


Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver diseases that affect >25% of the world’ population. NAFLD is associated with substantial morbidity and mortality of liver cirrhosis, hepatocellular carcinoma, diabetes mellitus, and cardiovascular diseases, which leads to a significant healthcare burden and a decrease in quality of life in a patient. According to international guidelines, lifestyle modification for weight loss remains the first-line intervention in patients with NAFLD. The article summarizes evidence-based recommendations for lifestyle changes and clinical management of patients with NAFLD.

Vrach. 2022;33(5):9-13
pages 9-13 views


The use of zirconium dioxide in surgery: advantages and disadvantages of the material, evaluation of the effect of zirconium dioxide on osteosynthesis

Sarkisyan N.G., Astryukhina P.I., Shamrai V.I.


Today, clinical medicine provides a variety of procedures and materials for bone structure restoration in surgery. The use of zirconium oxide and its alloys is a new and little studied method to restore bone structures. A number of issues, such as the quality and timing of integration of zirconium oxide, its biocompatibility with a living organism’s tissues and the effect on the latter, remain open in the use of zirconium dioxide. The purpose of the systematic review is to search for and analyze the studies that determine the prospects for the use of zirconium and its alloys in surgery, by taking into account the advantages and disadvantages of these materials.

Vrach. 2022;33(5):14-17
pages 14-17 views


Features of the course of COVID-19 and HIV co-infection

Eremushkina J.M., Kuskova T.K., Filippov P.G., Potekaeva S.A., Ogienko O.L.


With the high incidence of the novel coronavirus infection (NCI; COVID-19), the prevalence of comorbidity, HIV infection in particular, is increasing worldwide. Objective. To assess the features of the course of the comorbidity of COVID-19 and HIV infection. Material and methods. A total of 584 case histories of patients with COVID-19 and HIV co-infection were retrospectively analyzed. Randomly selected 52 case histories of patients with this co-infection, of them there were 15 fatalities, are considered in more detail. Statistical analysis was carried out using SPSS16 software; and case descriptions were also applied lest the important data are lost in the global frequency population and fall into outliers or anomalies. Results. The hospitalized patients had different HIV infection stages; there was a preponderance of patients with stage IVB disease; most of whom did not receive antiretroviral therapy (ART) and had profound CD4+ T-lymphocyte immunodeficiency and a high viral load. Some patients had also an unfavorable premorbid background. At the initial hospitalization stages, the clinical presentation of the disease in 13% of the patients could not clearly differentiate COVID-19 and opportunistic infections affecting the respiratory organs. The impact of mutual aggravation of the course of the diseases was observed in patients with severe HIV infection and COVID-19. Of particular interest was a group of 20 patients with coinfection who had received ART before their hospital admission. One third of these patients were noted to have a HIV viral load in the presence of COVID-19. Conclusion. A number of HIV-infected patients showed a favorable course of COVID-19 during ART and scheduled therapy for COVID-19. In the early stages of the disease, HIV reactivation was observed in inpatients with COVID-19 who received ART. This was regarded as a surge in HIV viremia in some cases and as virus reactivation and the possible development of antiviral drug resistance in others.

Vrach. 2022;33(5):18-23
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The efficacy of Nervo-Vit in premenopausal patients: its effect on social activity, anxiety, and quality of life

Khabibulina M.M., Shamilov M.D.


The natural sedative drug Nervo-Vit was studied for its effect on quality of life (QoL), anxiety, and social activity in 58 premenopausal patients with hypoestrogenemia. The health, activity, mood questionnaire and Short form 36 (SF-36) Health Quality Survey questionnaire were used. The Hospital Anxiety and Depression Scale (HADS) was employed to assess psychological characteristics. The stressful impact of estrogen deficiency on the social aspects of life in the examinees was measured by visual and spatial subscales (D.V. Sheehan). Therapy with Nervo-Vit has been established to have a positive impact on the psychological state, social aspects, and QoL of premenopausal women with estrogen deficiency.

Vrach. 2022;33(5):24-30
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For Diagnosis

Organizational approaches to optimizing immunochemical methods for the diagnosis of age-associated and vascular diseases

Saginbaev U.R., Rukavishnikova S.A., Akhmedov T.A.


Immunochemical methods play an important role in clinical and research studies. When studying the pathogenesis of age-associated vascular diseases, it often becomes necessary to investigate several analytes. Objective: to elaborate an algorithm for optimizing enzyme-linked immunosorbent assay (ELISA) studies with a parallel comprehensive assessment of several indicators determined in the investigation of age-associated and vascular diseases, atherosclerosis in particular. The materials were test systems for ELISA of a number of indicators characterizing the state of immunity, vascular wall, and metabolism. The duration of the study is one of the problems of immunochemical analysis of analyte panels. To solve this problem, the authors propose a parallel approach to conducting ELISA, which makes it possible to save about 16 hours. With this approach, the target analytes are grouped by the duration and multiplicity of incubation, the number of calibrators and other criteria. Thus, the described logistic principle that is able to substantially optimize a immunochemical study can be successfully applied in the comprehensive assessment of the causal relationships between age-associated and vascular diseases.
Vrach. 2022;33(5):30-33
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Possibilities of diagnosing the use of marijuana and amphetamine from changes in the microcirculatory bed

Kutsenko V.P., Kovaleva D.D., Peresada E.I., Seliverstov P.V.


The diagnosis of the use of narcotic drugs is based on different methods and techniques, which have both positive and negative effects of objective and subjective nature. Therefore, the development of different methods for diagnosing the use of narcotic drugs, such as amphetamine and marijuana, remains an urgent problem of modern health care. One of the simple and non-invasive methods is capillaroscopy that allows one to determine changes in the microcirculatory bed when exposed to various chemicals, including narcotic ones.

Vrach. 2022;33(5):34-39
pages 34-39 views

From Practice

Risk factors for recurrence and severity of an ulcerative colitis attack

Bolotova E.V., Yumukyan K.A., Dudnikova A.V., Yakovenko M.S.


Objective. To analyze risk factors for recurrence and severity of an ulcerative colitis (UC) attack. Material and methods. A retrospective study that included 315 medical records of UC patients (167 and 148 Inpatient and outpatient records, respectively) was conducted. Results. Patients with recurrent UC requiring hospitalization were observe to have statistically significantly increases In the duration of the disease, in the frequency of exacerbations/exacerbations in their history and the frequency of using biological agents, a younger age at the onset of UC, alow status of current smoking and ex-smoklng as compared with those in patients In remission. Severe UC was associated with the following factors: a young age at the onset of UC; a lower body mass index, a history of biological therapy; a positive fecal occult blood test at the time of hospitalization; lower hemoglobin and albumin levels; higher erythrocyte sedimentation rate and C-reactive protein; a large extent of intestinal damage; and deep ulcerative defects in the colon mucosa. Conclusion. Analysis of risk factors for recurrence and severity of an UC attack aids In the personalization of treatment, In the prediction of therapeutic response, In the evaluation of the likelihood of adverse effects, and in the optimization of the early diagnosis of the risk of relapse In UC and Its severe attack.

Vrach. 2022;33(5):40-45
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Successful case of treating a patient with associated trauma with rupture of the thoracic esophagus

Yurov S.V., Vinnik Y.S., Serova E.V., Bolshakov V.N., Dudarev A.A., Saverchenko A.M., Kovrigin V.V., Nesterov V.R., Zima A.Y.


This report presents a case of successful treatment of a patient with severe concomitant trauma with damage to the thoracic esophagus. The article shows that a rupture of the esophagus is a rare, poorly diagnosed, but very serious complication, in particular, a road injury, accompanied by the rapid development of mediastinitis, sepsis, which worsens the course of traumatic illness and requires long-term, multicomponent treatment.

Vrach. 2022;33(5):47-50
pages 47-50 views

Difficulties in the diagnosis and differential diagnosis of panniculitis in therapeutic practice

Kozyrev O.A., Bazina I.B., Krechikova D.G., Korneeva I.G., Vinogradova E.V., Mayorova A.V., Makarova O.Y.


Panniculitides are called a group of diseases that are dissimilar in etiology and clinical and morphological patterns, the main manifestation of which is inflammation of subcutaneous adipose tissue to form skin nodules. Diagnosis in therapeutic practice is complicated by the need for an extensive examination for differential diagnosis and exclusion of other diseases. The paper considers a clinical case of a female patient with panniculitis, the complexity of its diagnosis and differential diagnosis.

Vrach. 2022;33(5):50-55
pages 50-55 views

Modern method for treatment of acute thrombosis of the surface vins of the lower limbs

Krivoschekov E.P., Poseryayev A.V., Elshin E.B., Alyapyshev G.S.


The article presents the results of the analysis of the method of conservative treatment in patients with thrombosis of the great saphenous vein of its tributaries using the direct oral thrombolytic agent. The results of treatment of two similar groups of patients who received therapy at the inpatient and outpatient stages of treatment were analyzed. Domestic and foreign literature on relevant topics was analyzed.

Vrach. 2022;33(5):55-58
pages 55-58 views

Novel coronavirus infection (COVID-19): epidemiology, clinical characteristics of patients, risk of complications, prevention, use of selenium-containing drugs

Dedov D.V.


The article presents an analysis of Russian and foreign publications. The authors reflected the epidemiology, clinical characteristics of patients and risk of complications in patients with novel coronavirus infection (COVID-19). They noted correlations of selenium (Se) deficiency and severity of the course of the said disease. Se deficiency was associated with oxidative stress, hyperinflammation, complications of COVID-19. Showed the need for sufficient serum Se for proper functioning of the immune, reproductive systems, thyroid gland, brain. Recognized that the organic form of Se (selenocystin) had high bioavailability. Concluded that the severity of the course of COVID-19, along with other risk factors, may be related to the low serum Se content of patients. Additional prescription of selenium-containing drugs requires an individual approach, considering the data of complex clinical and instrumental examination, comorbid diseases existing in patients. Administration of SELENBIO for women may be recommended for complex prophylaxis of COVID-19, increasing of body adaptation potential and maintenance of healthy immune system.

Vrach. 2022;33(5):58-62
pages 58-62 views

Improving the esthetics of maxillary anterior teeth with E-max all-ceramic structures

Okromelidze M.T., Chikunov S.O., Utyuzh A.S., Shirshov S.V.


There is currently an increase in demand for aesthetic dentistry. It is important to make a step-by-step course of treatment in advance and to plan a future result. At the same time, the restoration of anterior teeth must be reliable and durable. Objective. To study therapeutic measures to replace hard tissue defects with E-max all-ceramic structures. Material and methods. The paper describes a clinical case of aesthetic defects in the anterior teeth of a female patient. Orthopedic treatment was performed using E-max all-ceramic structures. Result. Aesthetic tooth defects in the maxillary frontal area were eliminated, which could improve quality of life in the female patient.

Vrach. 2022;33(5):62-65
pages 62-65 views

The possibilities of using the peptide complex PROTECTOR 3 Plus

Potupchik T.V., Yashin A.A.


The article describes the role of peptide bioregulators in maintaining the structural and functional homeostasis of the body. The features of the use of peptide complexes with high antioxidant activity, anti-inflammatory, immunostimulating and antistress effects are presented. The peptide complex PROTECTOR 3 Plus, characterized by a high safety profile, can be recommended for improving the immune and endocrine systems at any age, improving the quality of sleep and emotional state, with asthenic disorders, including postcovid syndrome; in the complex therapy of cancer patients.

Vrach. 2022;33(5):65-68
pages 65-68 views

Comparative experience of combined medicine interferon alpha-2b + betamethasone and azelastine in the treatment of pollinosis

Trukhan D.I., Alekseenko V.A., Kalashnikova N.M., Minayeva V.Y., Shelyapina O.V., Nesterova K.I., Bagisheva N.V., Mordyk A.V., Goloshubina V.V., Moiseeva M.V., Vins O.N., Nebesnaya E.Y.


Objective. To assess and compare effectiveness of the combined medicine interferon alpha-2b + betamethasone (Allergoferon® beta) and azelastine in the topical treatment of pollen allergy (pollinosis) excerbations. Materials and methods. The study design was open, prospective, randomized and comparative. This study was conducted on the basis of the Department of Allergology and Immunology of the Omsk City Polyclinic No.12. The study included 100 patients (men and women aged 18 to 55 years) who had consulted an allergist about moderate pollen allergy exacerbations. The patients were divided into two groups according to the treatment received: Group 1 (n=50) patients received azelastine for the treatment of pollinosis exacerbations; Group 2 (n=50) patients - the new combined medicine Allergoferon® beta. Patients’ conditions were assessed at baseline (Visit 1; V1) and during follow-up examinations on the day 7 (Visit 2; V2) and day 14 (Visit 3; V3). Patients’ symptoms and signs were examined, which helped to evaluate the therapy effectiveness, the presence and severity of side effects. The therapy effectiveness of pollen allergy exacerbations with these medicines was determined by analysing the frequency dynamics and clinical manifestations severity of disease exacerbations during treatment. Tolerability of the examined medicines was evaluated according to patients’ subjective assessment. Results. Control examinations of patients were conducted on the 7th and 14th days of treatment. On the 7h treatment day (V2) a positive dynamic was noted in both groups. Disappearance of nasal symptoms (rhinorrhoea -0 points) was observed in 20% of group 1 patients and in 36% of group 2 patients (x2=3,59; p=0,058); resolution of ocular symptoms (itchy eyelids - 0 points) - in 16 and 24% of patients in groups 1 and 2 respectively (x2=1,33; p=0,248); absence of cough - in 20 (group 1) and 24% (group 2) of patients; absence of sneezing - in 24 (group 1) and 36% (group 2) of patients. After 14 treatment days (V3) nasal symptoms (nasal congestion - 0 points) were fully resolved in 50 and 70% of patients in groups 1 and 2 respectively (x2=2.09; p=0.148); ocular symptoms (itchy eyelids - 0 points) resolved completely in 40 (group 1) and 64% (group 2) of patients (x2=3.67; p=0.055); no lacrimation was observed in 56 (group 1) and 72% (group 2) of patients (x2=1.22; p=0.268). Conclusion. Following the study results, it was noted that the use of the combined medicine interferon alpha-2b + betamethasone (Allergoferon® beta) for the treatment of patients with moderate pollen allergy exacerbations allowed us to resolve ocular and nasal disease symptoms quickly and effectively. No side effects were observed, patients noted a good tolerability of this medicine. There were no cases of treatment withdrawal or refusal.

Vrach. 2022;33(5):68-77
pages 68-77 views

Possibilities of using calcium lactate in combination with a prebiotic complex in the therapy of chronic dermatoses

Katkova K.V., Ramazanova T.R., Belenkova A.A., Denisova E.V., Korsunskaya I.M., Kolodkin A.M.


There is now a lot of scientific evidence suggesting that the gut microbiome affects many human body organs, including the skin. In this connection, intensive study is being given to the possibility of including drugs that favors normalization of the composition of intestinal microflora in order to improve the skin process. These agents may include metabiotics and prebiotic complexes that contain substances that activate the growth of normal flora. There is evidence of a fairly common occurrence of dysbiosis and gastrointestinal disorders in atopic dermatitis (AD) and psoriasis. In this regard, the authors observed patients with AD and psoriasis who received combination therapy including calcium lactate and a prebiotic complex. The severity of symptoms was reduced just on days 3-5 days; whereas there was a significant clinical effect by day 14 of treatment. However, the mechanism of action of prebiotics on the course of psoriasis and AD requires further study.

Vrach. 2022;33(5):78-82
pages 78-82 views

Transcranial electrical stimulation and the anxiolytic fabomotizole in the combination therapy of patients with lichen ruber planus

Tlish M.M., Osmolovskaya P.S.


Considering stress as one of the important triggers of lichen ruber planus (LRP), it is promising and expedient to include effective and safe methods aimed at its correction in the therapy of these patients. Objective. To evaluate the efficiency of combination treatment with transcranial electrical stimulation (TES) and the anxiolytic fabomotizole in patients with LRP. Methods. An open, prospective, comparative study involving 67 patients (mean age 44.10±15.78 years) with a common typical form of LRP was conducted. All the patients received the therapy in accordance with the federal clinical practice guidelines (chloroquine 250 mg orally twice daily; topical glucocorticosteroids). Adaptive randomization was used to divide the patients into 2 groups: 1) a study group including 33 (49.3%) patients who were prescribed TES and the anxiolytic fabomotizole in addition to standard therapy; 2) a comparison group consisting of 34 (50.7%) patients who received TES in addition to standard therapy. The therapy results were assessed on days 7,14, and 21. The examination algorithm included the assessment of clinical manifestations with consideration for the Lichen Planus Severity Index (LPSI); the severity of itching and its impact on the daily life of patients (Behavioral Rating Scale (BRS); the study of the psychoemotional background by using the Dermatology Life Quality Index (DLQI), the Hamilton Anxiety Rating Scale (HAM-A), and the Hamilton Depression Rating Scale (HAM-D). Results. Before starting of the treatment, there were no statistically significant differences (p>0.05) in the groups in terms of the studied indices and scales. On day 7 of therapy, the study group patients achieved significantly more favorable results in terms of the studied parameters (LPSI, DLQI, BRS, HAM-A, and HAM-D). According to the BRS, just on day 14 the study group patients had the median of 0 scores (interquartile range, 0-0), while the comparison group achieved those only on day 21. Conclusion. The combination treatment with TES and fabomotizole in the study group patients with LRP showed higher efficiency than that in the comparison group that had been additionally prescribed only TES.

Vrach. 2022;33(5):83-88
pages 83-88 views

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