Vol 33, No 12 (2022)

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.

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.

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.

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.

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.

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.

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.

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 α_1A-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 α_1A-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 α_1A-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 α_1A-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 α_1A-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.

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.

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.

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.