Vol 34, No 2 (2023)

Implementing the tasks to reduce the burden of tuberculosis (TB) in Russia while striving for the declared WHO indicators weighs primarily on the general medical network. The main condition for reducing the incidence and prevalence of TB is its timely diagnosis with a comprehensive examination of the patient. The issues of the interaction with the anti-tuberculosis service begin at the stage of screening activities among the population or examination of a patient with complaints in suspected TB. The paper presents main information from the existing guidelines on adult TB, which is necessary in general medical practice, and the reasons that reduce the effectiveness of anti-tuberculosis measures.

The skin is structurally a complex barrier organ that forms an original dynamic ecosystem colonized by a wide range of bacteria, fungi, viruses, and mites. The skin microbiome plays an important role in maintaining homeostasis and the state of local immunity and affects pathogenic microorganisms and skin barrier function through bacterial enzyme production. The most frequent and common infectious skin lesions are pyoderma, atopic dermatitis, psoriasis, hidradenitis suppurativa, acne vulgaris, rosacea, seborrheic dermatitis, various mycoses, as well as bacterial and fungal folliculitis. A detailed study of the impact of homeostatic balance on the health of the skin plays an important role in the diagnosis and treatment of skin diseases. Further investigations and deciphering bacteria, fungi, and viruses colonizing the skin will contribute to more effective diagnosis and identification of associations between the microbiota and the occurrence of various diseases, as well as to the development of more effective methods for their treatment, which is of great importance in clinical practice.

Molecular genotyping opens up fresh opportunities to search for a more targeted and personalized approach to treating occupational asthma (OA) and to developing an individual strategy for its prevention.

Objective. To determine genetic risk markers for OA under the influence of sensitizers, by assessing IL5 rs2069812 polymorphic variants.

Subjects and methods. The investigation enrolled 170 patients with different OA phenotypes. The patients were divided into groups according to the OA phenotype: 1) 42 patients with an allergic OA phenotype; 2) 36 patients with a non-allergic OA phenotype; 3) 58 patients with an OA + occupational chronic obstructive pulmonary disease (COPD) phenotype; 4) 34 patients with an OA + metabolic syndrome (MS) phenotype. A control group included 50 healthy individuals. IL5 rs2069812 polymorphisms were determined as part of the study of genetic predisposition to OA. Phenol chloroform extraction was used to isolate DNA from peripheral lymphocyte samples. Genotyping was done by real-time polymerase chain reaction with primers and probes designed using the PrimerQuest program (Integrated DNA Technologies, Inc., USA).

Results. The genetic markers for OA were found for the first time after exposure to sensitizers, IL5 rs2069812 polymorphic variants, which can recommend that this genetic marker should be identified during thorough periodic medical examinations in individuals with clinical, functional, and immunological changes upon occupational exposure to sensitizing and irritating substances.

Conclusion. The identified marker profiles of the genotypes of OA can optimize an approach to diagnosing, treating, and preventing this disease, and expanding the range of criteria for predicting its course. When a polymorphism in the IL5 gene is detected using a molecular genetic study, the patient needs to be registered for follow-up, repeated respiratory function tests once every six months, thorough periodic medical examinations in a specialized center of occupational pathology, by obligatorily attracting a pulmonologist, an allergist/immunologist, and an occupational pathologist, as well as extensive functional and immunological studies once every two years.

The lymphatic system is an integral part of the microcirculatory bed, which structurally and functionally complements the venous bed. It ensures constancy in the internal environment of the human body and performs transport, barrier, lymphopoietic, and immune functions, playing an exceptional role in the metabolism and cleansing of the body’s cells and tissues from metabolic products.

The researchers assume that the meningeal lymphatic vessels (MLVs) may be involved in the process of cleansing the brain from metabolic products. Today, the problem of proving the existence of MLVs is a key one in understanding the anatomy and physiology of processes in the brain as a whole. Medical imaging techniques make it possible to prove the presence of MLVs. The paper analyzes the methods that are currently more frequently used to determine MLVs.

Experimental medical imaging techniques allow us to conduct researches, by confirming or ruling out the scientific theories put forward. These methods are further evidence-based medicine.

Research in recent years has provided much information about the overall composition and function of the gut microbiota. It has been established that the microbiota contributes to maintaining the integrity of the mucosa, providing nutrients, protecting against pathogens, etc. In addition, the interaction between the microbiota and the mucosal immune system is crucial for the formation of adequate immunity. Thus, understanding the human microbiota can be directed towards better diagnosis and rational treatment of many human diseases. The use of probiotics in various nosological forms demonstrate encouraging results. Diseases of the gastroenterological profile and not only often require the appointment of probiotics. The main mechanisms underlying the beneficial effects of probiotics are considered from the standpoint of their pleiotropic action. The choice of multi-strain probiotic preparations is preferable and justified from the point of view of the synergy of its constituent microorganisms, which allows achieving the best effect. The latest generation of probiotics with an innovative protective double shell demonstrate high clinical efficacy due to the preservation of the viability of probiotic microorganisms in the gastrointestinal tract.

Aim. To carry out a comparative analysis of the cost of a "unit of effect" of emoxipin, ethoxidol and mexidol used to improve the quality of life of women receiving radiation therapy after surgical treatment of endometrial cancer.

Materials and methods. The pharmacoeconomic analysis was carried out in accordance with the Guidelines for Calculating Costs in Conducting Clinical and Economic Studies of Medicinal Products and included determining the position of the study and the list of costs, the time period for cost accounting and cost calculation. The results of the use of the studied drugs were evaluated according to the previously published dynamics of integrative indicators of QL according to the generic questionnaire SF-36 and the cancer-specific questionnaire for patients with endometrial cancer FACT-En. In the course of the analysis, a comparison was made of the direct costs (Cost, in rubles) for the purchase of each of the studied drugs with the consequences (Ef) of their course use. The result of the pharmacoeconomical analysis was expressed in the form of a cost-effectiveness coefficient (CER = Cost / Ef) per patient.

Results. As a result of the clinical and economic analysis, it was found that in most cases mexidol is characterized by the lowest cost-effectiveness ratio. This concerns the calculation of CER according to the dynamics of the integral indicator (TS) of the questionnaire for the functional assessment of endometrial cancer therapy (FACT-En) and the psychological component of health (MH) according to SF-36. The exception was the result of the calculation of "cost-effectiveness" according to the criterion of increasing PH – the physical component of health according to SF-36. In this situation, mexidol was inferior to ethoxidol in terms of pharmacoeconomic efficiency. In all cases, without exception, the most expensive was the use of emoxipin.

Conclusion. According to the pharmacoeconomic criterion "costs - effectiveness", the most expensive is the use of emoxipin, and the least expensive is the use of mexidol. In all cases, the "cost per unit effect" of emoxipin was 3-6 times higher than the corresponding indicators of mexidol and ethoxidol.

The increased incidence of COVID-19 and HIV coinfection and the changes in the structure of HIV infection mortality during the pandemic necessitate an analysis of the causes of adverse outcomes in co-infection.

Objective. To retrospectively analyze deaths in patients with COVID-19 and HIV coinfection in the stage of secondary diseases.

Subjects and methods. The investigation involved the medical records of 56 patients with laboratorily confirmed COVID-19 and HIV infection who were hospitalized in January to December 2021.

Results. A retrospective analysis of the medical reports showed that bilateral polysegmental pneumonia of mixed etiologies was the cause of death in the majority cases of COVID-19 and HIV coinfection in the stage of secondary diseases. Along with pneumonia, multiple opportunistic diseases and conditions, which aggravated the course of the underlying disease, were identified in these patients. Various somatic diseases are one of the reasons for the severe course of the coinfection.

Conclusion. Stage IVB HIV infection was diagnosed in the majority of deaths. Bilateral polysegmental pneumonia of mixed etiologies was the most common cause of death in patients with COVID-19 and HIV coinfection in the stage of secondary diseases.

Objective. To assess the frequency of iron deficiency states among reproductive-aged women and to consider the features of their prevention.

Subjects and methods. The investigation enrolled 2401 reproductive-aged patients who came first to the Clinic of the Kuban State Medical University in 2019. The patients’ mean age was 36.71±6.32 years; the follow-up period was 36 months.

Results. Iron deficiency and iron deficiency anemia (IDA) were detected in 518 (21.6%) and 591 (15.9%) patients, respectively. At the same time, IDA was mild, moderate, and severe in 383 (15.9%); 202 (8.2%), and 6 (0.5%) patients, respectively. New-onset anemia was recorded in 70.3% of patients. A re-examination was carried out after 36 months, which involved 1917 patients (79.8% of the baseline patients). A total of 156 (8.1%) patients were diagnosed with mild and moderate (in 149 (7.7%) and 7 (0.3%) patients, respectively; latent iron deficiency was identified in 518 (21.6%) patients. At the same time, IDA was undetected in the patients who had followed the recommendations for prophylactic iron supplementation after reaching the target levels of serum hemoglobin and ferritin.

Conclusion. An integrated approach that includes the informing of a patient about iron deficiency consequences, etiotropic and pathogenetic treatment, preventive drug use recommendations, and dynamic monitoring, assist in overcoming iron deficiency in reproductive-aged women.

Objective: to evaluate the impact of the rehabilitation with the inclusion of virtual reality technology and robotic mechanotherapy on the speed and biomechanics of walking in patients with coxarthrosis after hip arthroplasty.

Material and methods. The sample consisted of 40 patients aged 40–80 years after hip arthroplasty for coxarthrosis. Within 14 days, patients of the main group (n=20) received a new complex of physical therapy, including robotic mechanotherapy and training on a system with virtual reality technology, in the control group (n=20) – a standard rehabilitation complex.

Results. In the main group, a decrease in the level of pain according to VAS by 41.7% (p=0.023 compared with the baseline; p=0.047 compared with the control group), as well as an increase in walking speed (by 20.5%; p= 0.028) and a decrease in step width (by 8.2%; p=0.048). Also, in the main group, there was a decrease in the time to complete the "Get up and walk" test (by 15.4%; p=0.043) and an increase in walking speed according to the ten-meter test (by 23.9%; p=0.039). There were no significant changes in data in the control group (p>0.05).

Conclusion. A new rehabilitation complex, including methods of mechanotherapy and virtual reality, is recommended for the rehabilitation of patients with coxarthrosis after arthroplasty.

Among the protective factors of mixed saliva, antimicrobial peptides have received much attention. They have broad-spectrum antibacterial and antifungal activities. Synthetic peptides are found in hygiene products, such as mouthwashes, sprays, and toothpastes. According to their manufacturers, the use of these products helps prevent oral bacterial infections.

Objective. To study the effect of toothpastes and mouth spray, which contain synthetic peptide complexes, on the physicochemical parameters of mixed saliva in order to substantiate their preventive antibacterial effect.

Material and methods. Mixed saliva from patients was examined before and after the use of the synthetic peptide-containing spray and toothpaste. The following salivary physicochemical parameters (pH, surface tension, and base buffer capacity) were measured.

Results. The peptide-containing spray and toothpaste caused changes in the oral fluid pH within the normal range, which assisted in maintaining oral homeostasis and in effectively exerting the functions of mixed saliva. When the spray or toothpaste was used, the base buffer capacity was slightly reduced, which suggested that the synthetic peptides were able to neutralize oral fluid acids and thereby to enhance the anti-inflammatory and antibacterial functions of mixed saliva. The surface tension of saliva was increased with the peptide-containing spray and that was decreased with the peptide-containing toothpaste. This effect indicated the active ability of the synthetic peptides to be absorbed into blood and to have a direct effect on cell metabolism at the site of lesion (when using the spray), as well as the ability of the complexes to integrate into the colloidal system of saliva, which enhanced its reparative and protective properties (when using the toothpaste).

Conclusion. The study shows an increase in the antibacterial effect of mixed saliva when using oral hygiene products containing peptides, which contributes to the prevention of risk factors for inflammatory diseases of the oral mucosa and periodontium.

The paper deals with the actual problem of modern medicine, namely, the analysis of the association of headache (HA) in adolescents with the presence and severity of anxiety compulsive disorders. It presents information on the prevalence, etiology, and clinical manifestations of primary HA in children and adolescents. The characteristics of the components (phobic anxiety and compulsiveness) of the psychoemotional status are given. The authors present the results of their own study showing that frequent episodes of HA are associated with the greater severity of compulsive disorders and phobic anxiety. They highlight approaches to correcting anxiety and preventing its negative impact on the occurrence of HA. The need for further researches in this direction is emphasized.

The article presents the results of duplex scanning of the common carotid arteries (CCA) and assessment of the structural and functional state of the vascular bed women with arterial hypertension (AH) with hypoestrogenemia. It was found that in patients with hypertension with a reduced level of estradiol, there is an expansion of the lumen of the CCA, a decrease in the speed of blood flow in the carotid arteries of a rectilinear course, without hemodynamically significant stenoses, which indicates structural and functional changes in the vascular wall. In the studied patients, in almost every third case, an inertial type of vasomotor reaction is detected before treatment, which indicates the contribution of dishormonosis to the progression of hypertension due to an increase in the stiffness of the vascular wall and the development of endothelial dysfunction. Combination therapy with BioDihydroquercetin and ACE inhibitor improves the structural and functional characteristics of the vascular wall of the CCA, has a positive effect on endothelial dysfunction, reduces the stiffness of the vascular wall of the arteries compared with patients taking ACE inhibitor monotherapy. The drug BioDihydroquercetin, produced with trade mark “Baikal Legend”, is a natural antioxidant, capillaroprotector, strengthens blood vessels, improves blood microcirculation, and is recommended to slow down the aging process of the body.