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Vol 33, No 12 (2022)

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Integrative medicine and aging prevention: state-of-the-art

Ashikhmin Y.I., Ratnikova A.K., Felsendorff O.V., Melnikov A.Y., Dikur O.N., Grudina M.O.


Health care focuses primarily on the treatment and prevention of specific diseases, while there are very few high-quality studies of the prevention of aging and the maintenance of high quality of life (or improvement) in healthy people. This review considers the most effective and evidence-based integrative medicine methods used in apparently healthy people for their health improvement.

Vrach. 2022;33(12):5-10
pages 5-10 views


Analysis of diagnostic methods for planning orthodontic treatment of children with dentoalveolar anomalies used in public and private dental institutions of the Russian Federation

Admakin O.I., Grinin V.M., Bille D.S., Moroz A.B., Tatulyan A.R., Mammedova S.R.


Qualified and effective orthodontic treatment is intended to assist the population both in public and private dental medical organizations in order to prevent dental anomalies in children and adults. A comprehensive study of the patient's dentoalveolar system includes the following diagnostic methods: clinical external and intraoral examination, photo protocol, anthropometric measurement of the face and plaster diagnostic models, teleroentgenogram and orthopantomogram, electronic axiography, as well as regular use of gnatostat. All these basic and additional diagnostic methods are necessary for making the correct diagnosis and planning further treatment of patients. Unfortunately, both public and private medical organizations do not always provide the full range of diagnostic services. Therefore, to solve this problem, it is necessary to introduce measures that allow dental clinics to reach a higher level of quality orthodontic services. Since highly qualified orthodontic treatment is the key to favorable growth and development of the craniomandibular system of the child.

Vrach. 2022;33(12):11-16
pages 11-16 views


On antiarrhythmic therapy in a patient with dilated cardiomyopathy: a clinical case

Sveklina T.S., Kuchmin A.N., Galova E.P., Kazachenko A.A., Tyuryupov M.S., Reshetova Y.V.


The paper gives modern ideas about the problem of ventricular arrhythmias in patients with dilated cardiomyopathy. It considers a clinical case that shows the complexity of managing patients with this profile. The authors also show the combined use of pharmacological and surgical treatments for frequent ventricular premature beats and persistent paroxysmal ventricular tachycardia. They also analyze and summarize current studies and clinical guidelines for the management of patients with arrhythmias refractory to the main classes of drugs.

Vrach. 2022;33(12):17-20
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Functional somatic disorders in adolescents with various online behavior (on the example of the city of Krasnoyarsk)

Kostyuchenko Y.R., Potupchik T.V., Evert L.S., Dubrovsky Y.A., Usoltseva E.I., Loseva N.I., Panicheva E.S.


A review of data on the most common functional somatic disorders (FSD) in adolescent populations from different countries, different age-sex and ethnic groups was carried out. Definitions and characteristics of these types of pathology are given. The results of our own study, which showed the frequency of occurrence, structural features and comorbid associations of a number of FSDs (recurrent cephalgia, abdominal pain, back pain, asthenic syndrome) with the type of online behavior and their closer relationship with non-adaptive and pathological (Internet-dependent) behavior, are included. teenagers. Of the 3135 adolescents surveyed in Krasnoyarsk, 51.0% were characterized by adaptive internet use (AIU), 42.4% – non-adaptive (NIU) and 6.7% – pathological (РIU). The authors come to the conclusion that it is necessary to analyze the characteristics of adolescents using the Internet for early diagnosis and prevention of functional somatic disorders associated with maladaptive types of online behavior (NIU and PIU).

Vrach. 2022;33(12):21-26
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For Diagnosis

The informative value of computed tomography compared to plain radiography in diagnosing traumatic sacral fractures

Kutsenko V.P., Libert A.A., Menshikova S.V., Seliverstov P.V.


The sacrum evenly distributes the mechanical loading between the pelvis and the lower limbs. Sacral fractures make up a heterogeneous group of fractures, which, moreover, rarely occur as isolated fractures. They are usually associated with fractures of the pelvis and pelvic ring. Due to the low incidence, heterogeneity, and in some cases the isolated nature of the lesion, this group of fractures often remains undiagnosed early enough. Diagnostic mistakes could lead to serious consequences for the patient's health in the future, primarily neurological complications.

Nowadays there is a tendency of an increasing frequency of correctly and early diagnosed isolated traumatic sacral fractures, which happens because of the spread of using computed tomography (CT) as the method of choice for diagnosing this pathology. CT is the most preferred method for the primary differential diagnosis of traumatic sacral fractures. This method is of high sensitivity and specificity, much ahead of a plain X-ray, and is as well accessible and simple.

Vrach. 2022;33(12):26-32
pages 26-32 views

From Practice

Comparative analysis of data from the outpatient electronic medical records of patients of different ages with chronic heart failure: results and problems

Chernyavskaya T.K., Kakorina E.P., Samorodskaya I.V.


Objective. To determine clinical features and management tactics in patients with chronic heart failure (CHF) in three age groups, by analyzing their electronic medical records (EMRs).

Material and methods. EHRs were analyzed in 683 patients from healthcare facilities in the urban districts of the Moscow Region who sought medical assistance in 2021, in whom ICD-10 Code I50 (heart failure) was indicated as one of the diagnosis codes (for complications). For analysis, three groups were formed: 18–59 year-olds; 60–70 year-olds; and over 71-year-olds.

Results. Statistically significant differences were found in the frequency of recording hypertension (85, 90, and 94%, respectively), cardiomyopathy (5.6, 0.8, and 0.4%), prior COVID-19 infection (78, 26, and 17%), and in the rate of hospitalization for any cause (52, 43, and 63%). At the same time, there were no differences in hospitalization rates for diagnosed COVID-19 (4.4, 4.5, and 4.6%, respectively). The proportion of women in the sample increased significantly with age (32%, 49%, and 65%). The frequency of consultations in the third-level institutions or the Federal Center was 86; 79 and 69%, respectively (p < 0.0001). There were no differences in the frequency of using different groups of drugs (22.8; 20.2 and 22.9%), including triple therapy. The discussion presents the problems of evaluating patient management tactics based on EHRs.

Conclusion. The clinical and gender characteristics of patients with CHF and their management tactics differ in different age groups. However, the unstructured filling in of EHRs and a single data upload fail to fully assess the compliance of management tactics in CHF patients with clinical practice guidelines and to judge the efficiency of patient treatment.

Vrach. 2022;33(12):32-37
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Personal anxiety and its associations with stress at work in an open urban population

Akimov A.M., Bessonova M.I., Akimova E.V.


Psychoemotional stress in the workplace can adversely affect women's cardiovascular health. Due to the highest prevalence of personal anxiety (PA) among females, the problem under study has turned out to be particularly in demand not only for the populations of Europe and the world, but also for regional female populations.

Objective. To determine the associations between the high level of PA and stress at work in an open urban female population.

Subjects and methods. A cross-sectional epidemiological study was conducted on a representative sample of 1000 women aged 25–64 years, which had been formed from the voting lists of Tyumen citizens. The levels of PA and stress at work were determined using the standard WHO MONICA-MOPSY questionnaire.

Results. The open female population of a medium-urbanized city of Western Siberia showed a substantial prevalence of PA, while the level of the latter reaches its maximum in the fifth decade of life. The following causes of stress at work over the past 12 months were identified to include the need to do additional work (in more than one-third of respondents); a high responsibility in the workplace (in >50%); the lack of proper rest after a working day (in ~40%). The higher level of PA was associated with stress at work due to increased responsibility and with the lack of opportunities for rest after a working day.

Conclusion. Thus, the findings indicate the most vulnerable groups of women with a high level of psychosocial risk factors, which can serve as a scientific basis for the formation of comprehensive preventive programs to lower the risk of cardiovascular diseases in the female populations of medium-urbanized cities of Western Siberia.

Vrach. 2022;33(12):38-42
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Health self-rating and its association with the level of trait anxiety in an open population: a gender aspect

Kayumova M.M., Gakova A.A., Akimova E.V.


The results of studying the key determinants of population health have shown that health self-rating (HSR) is a multidisciplinary well-being marker formed as a result of the complex impact of various characteristics. At the same time, based on the proven associations of HSR with psychosocial risk factors (PSRFs), predominantly in women, there is a relationship between personal attitudes and the development and prognosis of cardiovascular disease.

Objective. To identify associations of the parameters of HSR with different levels of trait anxiety (TA) among women in an open urban population.

Subjects and methods. A cross-sectional epidemiological study was conducted among a representative sample of women aged 25–64 years; their response rate was 70.3%. The levels of TA and HSR were determined using the standard WHO MONICA-psychological Program (MOPSY) questionnaire.

Results. In the open urban population, 70% of women showed low HSR; there was a substantial reduction in HSR in the third to the fifth decade of life. There was a significant prevalence of a high level of TA (54.7%) and its absolute maximum in the fifth decade of life (67.3%). With a high level of TA, the minimum number of positive responses (“healthy”) was obtained for HSR, the presence of health complaints considerably prevailed over their absence.

Conclusion. Thus, the results obtained in this study conducted in the open urban population showed the most vulnerable groups of women with a high level of PSRFs, which can serve as a scientific basis for the development of comprehensive prevention programs to reduce the risk of cardiovascular diseases in female populations from the medium-urbanized cities of Western Siberia.

Vrach. 2022;33(12):42-47
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The features of psychosocial factors in menopausal disorders

Sulima A.N., Rumyantseva Z.C., Efremova N.V.


The features of the course and correction of menopausal syndrome (MS) are largely determined by concomitant psychosocial factors (PSRFs), as well as the presence of extragenital pathology. In this regard, the issues of studying PSRFs in women with MS and concomitant somatic morbidity are quite relevant.

The aim is to study the main PSRFs in women with MS and concomitant extragenital pathology.

Subjects and methods. A prospective comprehensive clinical, laboratory and psychosocial examination of 100 women with MS was conducted, which were divided into two groups: the main group – 50 patients with MS on the background of extragenital pathology; the control group – 50 patients with MS without extragenital pathology.

Results. The study revealed a significantly higher level of depression and reactive anxiety in women who complain of MS and suffer from extragenital pathology. These psychological disorders can be explained by a violation of stress coping mechanisms, as well as the predominance of immature styles of defense (passive aggression, detachment from the situation, somatization).

Conclusions. A complex of psychological problems leads to a deterioration in the quality of life with an average level of psychosocial stress. The obtained results should be used in the development of a complex of prognostic and therapeutic and preventive measures.

Vrach. 2022;33(12):48-51
pages 48-51 views

Modern pharmacotherapy for post-traumatic osteoarthritis

Povzun A.S., Kostenko V.A., Povzun K.A., Shchemeleva E.V., Sarvilina I.V.


The strategy and tactics for using the drugs that affect the pathobiochemical pathways of inflammation and structural changes in cartilage and synovial tissues in joint functional impairment (JFI) during post-traumatic osteoarthritis (PTOA) are an urgent public health problem.

Objective. To study the mechanism of action of and to evaluate the efficacy of parenteral chondroitin sulfate (CS; Chondroguard®, CS-Bioactive© Bioiberica S.A.U., Spain; ZAO Sotex PharmFirm, Russia) in patients with Stage 1 PTOA of the knee and grade 1 JFI.

Subjects and methods. A 50-day open-label prospective controlled randomized study was conducted. The study involved 64 patients with Kellgren-Lawrence X-Ray Stage I PTOA of the knee and grade 1 JFI, who were divided into 2 groups. Group 1 included 34 patients who received CS (Chondroguard®, 100 mg/ml) intramuscularly every other day; the first 3 injections were 1 ml each, with a good tolerance; the each dose of the 4th to 25th injections was 2 ml; the treatment cycle was 50 days) and meloxicam (Amelotex®, 15 mg/day); Group 2 consisted of 30 patients who took meloxicam (Amelotex®, 15 mg/day that could be reduced 7.5 mg/day and be discontinued). On study days 0 and 50, the patients underwent assessment of pain intensity using the visual analogue scale (VAS) and the WOMAC index, the functional state of the knee joint and the activity in daily life and active sports life by the Lequesne index; the safety of therapy was evaluated by the WHO and Naranjo scales; standard radiography and MRI of the knee were done evaluating the articular cartilage and calculating the T2 relaxation time. Laboratory testing for blood biomarkers included the determination of the concentration of ultrasensitive C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukins (IL)-1β and IL-6. The data were statistically processed using the Statistica 10.0 program (StatSoft, Inc., USA).

Results. CS therapy was well tolerated by patients and was accompanied by a considerable improvement in the pain intensity at rest and during movement according to the VAS (U test=7.79; p<0.0001) and the WOMAC index (U test=7.14; p<0.0001) and a significant reduction in JFI according to the Lequesne index (U test=7.79; p<0.0001). A statistically significant increase in T2 relaxation rates was recorded in Group 2 (meloxicam) (U test=6.72; p<0.0001) compared with that in Group 1 (CS + meloxicam) and with the level of this indicator at 0 visit. Group 1 (CS + meloxicam) exhibited a significant decrease systemic pro-inflammatory markers in the blood (CRP, IL-6, IL-1β, and TNF-α;p<0.0001), as well as a substantial reduction (to the level of reference values) in the concentration of D-dimer (p<0.0001) and fibrinogen (p<0.0001) in comparison to those in Group 2 that received the standard therapy regimen for PTOA of the knee.

Conclusion. The study results have indicated the efficacy and safety of using Chondroguard® in the combination therapy of patients with X-Ray Stage 1 PTOA of the knee and grade 1 JFI.

Vrach. 2022;33(12):51-58
pages 51-58 views

Immediate and long-term results of two eversion carotid endarterectomy techniques

Yarikov A.V., Smirnov I.I., Mukhin A.S., Kletskin A.E., Lyutikov V.G., Sergeev V.L., Fraerman A.P., Lipatov K.S., Ostapyuk M.V., Stolyarov S.I., Muravina E.A., Khasyanov M.K., Ponomareva A.I., Komkova E.F., Teleshova T.O., Nesterenko S.P., Shigorina A.A., Zaletova I.A., Levshakov V.A., Abramychev N.I.


Objective. To study the immediate and long-term results of the new modified technique of eversion carotid endarterectomy (ECEAE).

Subjects and methods. According to the type of surgical treatment, the patients were divided into 2 groups: a study group of 61 patients who underwent ECEAE according to the method developed by V.L. Sergeev et al. and a comparison group of 89 patients who had ECEAE according to the method described by R. Kieny. The immediate and long-term results of the two ECEAE techniques were assessed.

Results. No advantages of any of the ECEAE techniques were found in the immediate postoperative period. At the same time, in the long-term postoperative period, the incidence of non-fatal ischemic stroke ipsilateral to the side of surgery was 0% in the study group (ECEAE according to V.L. Sergeev) and 7.1% in the comparison group, the incidence of internal carotid artery restenosis was 1.7 and 11.7% respectively (p < 0.05). The two reconstruction methods were evaluated through mathematical modeling of blood flow.

Conclusion. The new ECEAE technique (according to V.L. Sergeev) exhibited its safety and effectiveness in the immediate and long-term postoperative periods. Thus, it can be recommended for its wide application in practical medicine.

Vrach. 2022;33(12):58-64
pages 58-64 views

Efficiency of lithokinetic therapy in nephrolithiasis: the role of compensatory mechanisms providing traffic of medium-sized stones in the ureter

Barinov E.F., Malinin Y.Y., Grigoryan K.V.


Аim of the study was to analyze the activity of receptors that control contraction (α2-adrenergic receptor, purine P2X1- and P2Y receptors, angiotensin AT1 receptor, TxA2 receptor) and relaxation of smooth muscle cells (adenosine A2 receptor) while maintaining and blocking α1A-adrenoreceptor during lithokinetic therapy (LCT) in patients with medium-sized calculi in the ureter.

Material and methods. The study was prospective and included 30 patients with effective (Group 1) and ineffective (Group 2) elimination of stones 11–13 mm in size. Differences in LCT related to the appointment of an α1A-adrenergic receptor antagonist. Analysis of the functional activity of receptors involved in the regulation of ureteral motility was performed in vitro on platelet suspensions. The following agonists were used: ATP, ADP, adenosine, epinephrine, angiotensin-2 (Sigma-Aldrich Chemie GmbH, Germany). Platelet aggregation was assessed by the turbidimetric method on a ChronoLog analyzer (USA).

Results. Before LCT, the reactivity of receptors was revealed, signaling pathways of which can modulate the violation of the traffic medium-sized calculi in the ureter. Effective elimination of calculi after 7–9 days of LCT with the functioning of the α1A-adrenergic receptor was reproduced in a cohort of patients with the presence of: hyperreactivity of the A2A receptor, P2X1 receptor and hyporeactivity of the α2-adrenoreceptor, TxA2 receptor. Ineffective elimination of calculi in LCT with an α1A-adrenoreceptor antagonist is associated with impaired intracellular signaling due to excessive activation of the α2-adrenoreceptor, P2X1 receptor, P2Y receptors, AT1 receptor, TxA2 receptor and desensitization of the adenosine A2A receptor. The hyperreactivity of the Gq-protein-coupled receptor system (GPCR system) can neutralize the effect of the administration α1A-adrenergic receptor antagonist, since the «crosstalk» of intracellular signaling is reproduced, resulting in the preservation of an excess level of intracellular Ca2+ in smooth muscle cells.

Conclusion. In vitro analysis of intracellular signaling, which regulates the entry of Ca2+ into the cell upon activation of the GPCR system and the removal of excess Ca2+ through the adenosinergic system, makes it possible to clarify the mechanisms that maintain the balance of relaxation and contraction of smooth muscle cells during the traffic of medium-sized calculi.

Vrach. 2022;33(12):65-70
pages 65-70 views

Surgical treatment of type 2 diabetes mellitus. Analysis of long-term remission

Neimark A.E., Danilov I.N., Shulyakovskaya A.S., Lapshina S.E., Kornyushin O.V., Salov M.A.


Type 2 diabetes mellitus (DM2) and obesity are diseases that have a negative impact on public health. They are associated with significant morbidity and mortality, and despite lifestyle changes and the possibility of conservative therapy, it is still difficult to achieve glycemic control. Currently, there are practically no studies in the Russian-language literature on long-term remission after surgical treatment of DM2. This review aimed to identify and summarize evidence of the long-term effect of bariatric surgery on remission of DM2. There is no relationship between the type of bariatric intervention and the fact of remission. Each of the operated patients showed a decrease in overweight and, as a result, an improvement in the course of DM2.

Bariatric surgery is now established as an effective and safe therapy for morbid obesity and its associated morbidities. Patients who have not achieved remission, despite this, have an improvement in the quality of life. Bariatric surgery also corrected or alleviated a number of other comorbidities of obesity.

Vrach. 2022;33(12):70-74
pages 70-74 views

Prevention of falls syndrome with visual function deficiency

Lev I.V., Gurko T.S.


Visual deficiency significantly limits the functional activity of patients and acts as a significant risk factor for falls syndrome, one of the leading geriatric syndromes, which is not given enough attention in patients with diabetic retinopathy and primary angle–closure glaucoma.

Objective. Substantiation of the main preventive measures of falls syndrome in geriatric practice among patients with visual deficits.

Subjects and methods. A copy of information from official medical documentation and a survey of patients and their relatives on the number of falls for the calendar year were carried out. The main and control groups were formed, in which the frequency of falls syndrome was studied. The main group included patients suffering from diabetic retinopathy and primary angle-closure glaucoma in the number of 236 people. The control consisted of 204 patients with general somatic pathology (ischemic heart disease, arterial hypertension et al) who do not have the above-mentioned ophthalmological diseases now in the anamnesis. Patients of both groups were assessed for visual acuity without correction and with correction, peripheral and central vision assessment according to standard methods.

Results. It was found that the incidence of the syndrome of falls 4 or more times over the past calendar year among patients suffering from diabetic retinopathy and primary angle-closure glaucoma is 45,6±3,2 cases per 100 examined and is significantly higher than in the control group – 18,7±2,7 cases per 100 examined (p<0,001). 3 falls over the past year, respectively, were detected in 38,2±3,2 cases examined and in 8,5±2,0 cases per 100 examined, 2 falls – in 23,4±2,7 cases and 9,6±1,7 cases, respectively. A decrease in the participation of the visual system in the control of the postural balance of patients with ophthalmic pathology is also shown.

Conclusion. To prevent the syndrome of falls, correction of visual deficit is necessary.

Vrach. 2022;33(12):75-78
pages 75-78 views

The prevalence of geriatric syndromes in patients of older age groups in the Voronezh region

Chernov A.V., Silyutina M.V., Taranina O.N., Saurina O.S., Alekhina A.V.


The paper presents the results of studying the prevalence of geriatric syndromes in patients of older age groups. It shows an association of these syndromes with age and with each other.

Vrach. 2022;33(12):79-81
pages 79-81 views

BCG vaccination. Is it double protection?

Amosova E.A., Khramkova O.A., Kozlova O.S.


С началом пандемии COVID-19 появилось предположение о возможной протективной роли БЦЖ-вакцины в отношении новой коронавирусной инфекции. В обзоре рассматриваются данные предположения, а также представлены важные в практической деятельности врачей правила проведения вакцинации. Особо выделены вопросы, важные в практической деятельности врача-педиатра. Вопрос существования связи COVID-19 и БЦЖ-вакцинации остается открытым и в данном обзоре не полемизируется.

Vrach. 2022;33(12):82-87
pages 82-87 views

Application of hawthorn blood-red and rosehip fruits in the drug Kardioton in the prevention of various diseases

Dedov D.V.


Purpose of the study. To study the possibility of using hawthorn blood-red and rosehip fruits in the drug Kardioton company "Parafarm" in the prevention of various diseases.

Material and methods. The analysis of 27 Russian and foreign publications reflecting the use of hawthorn blood-red and rosehip fruits in the drug Kardioton in the prevention of various diseases.

Results and discussion. Noted their cardiotonic, coronary dilation, hypotensive, antiarrhythmic, antispasmodic effect of hawthorn preparations. Reflected the growing interest in hawthorn and the prospect of its use to treat a number of diseases: intoxication, inflammation, arthritis, diabetes, hyperlipidemia, obesity, cancer. All biologically active substances of hawthorn and rosehip are preserved in the drug Kardioton ("Parapharm") in full through the use of whole plant parts, not extracts from them, and the use of unique technology for Russia cryoprocessing plant raw materials.

Conclusion. Drug Kardioton, produced by "Parapharm" on unique Russian technology for cryoprocessing from medicinal plants grown on their own fields in environmentally clean regions of Russia, has antioxidant, cardioprotective, hypotensive, hypocholesterolemic, anti-inflammatory, metabolic effect and can be used in the complex prevention of various diseases in addition to the main etiotropic, pathogenetic and symptomatic therapy, taking into account the individual approach.

Vrach. 2022;33(12):88-91
pages 88-91 views


Anniversary of Dmitry Anatolyevich Kudlai


On December 10, 2022, Dmitry Anatolyevich Kudlay, Corresponding Member of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor of the Department of Pharmacology of the Institute of Pharmacy of the Federal State Autonomous Educational Institution of Higher Education First Moscow State Medical University named after I.I. THEM. Sechenov of the Ministry of Health of Russia, Leading Researcher of the Federal State Budgetary Institution "SSC Institute of Immunology" of the Federal Medical and Biological Agency of Russia, Vice-President of JSC "GENERIUM" for the introduction of new medical technologies.

Vrach. 2022;33(12):92-92
pages 92-92 views

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