Vol 34, No 5 (2023)

Objective. To evaluate endosonographic images (EGI) for different peripheral lung lesions (PPLs) genesis, to identify patterns of malignancy in the differential diagnosis of tuberculosis (TB), mycobacteriosis (NTM), malignancy neoplasm, to compare the main combinations of variants of the echo characteristics of lung lesions visualized during rEBUS navigation with the data of a comprehensive microbiological, cytological and morphological studies.

Methods. A cohort retrospective study included 145 patients (81 women (mean age 44.94±0.24 years) and 64 men (mean age 47.91±0.24)), with newly diagnosed PPLs and with negative sputum TB tests, who underwent diagnostic navigational bronchoscopy (rEBUS) and surgical diagnostics, and EGI of PPLs was visualized with rEBUS. Depending on the final verification, were endosonographic images divided into 2 groups: the Neo group (n=63), whose biopsy (during bronchoscopic or surgical diagnosis) verified the malignancy PPls, and the TB+NTM group (n=82) – infectious PPLs caused by mycobacterial infection (73 cases – pulmonary TB, 9 cases – mycobacteriosis).

Results. It was established that differences were statistically significant in shape, contour/border, and the presence of inclusions (linear arcs, zones of hypo-anechogenesis) between the comparison groups. If there are echoic features of malignancy PPLs on EGI with rEBUS (irregular shape (found in 60,3%), lobulated shape (in 17,4%), visualized but blurred contour (in 57.2%), fuzzy/poorly visualized contour (in 25.4%), heteroechoic structure, with “linear arcs” (49.2%) with an air bronchogram (in 36,5%)), tissue bronchobiopsy (brush and TBBL) are priority for cytological and histological examination. If there are echoic features of delimited infectious inflammation on EGI of PPLs in rEBUS (round or oval shape (found in 34.1% of cases), definite, closed contour (in 78.0%), homoechoic structure (29,3%), heteroechoic structure with zones of hypo-anechoicity (in 32.9%) with an air bronchogram (in 23.2%)), bronchobiopsy is a priority, allowing to cover the largest area of the lungs (BAL) for microbiological examination (microscopy, PCR-RT, culture) in combination with tissue biopsy (cytological examination). A classification has been created that includes 3 types of EGI to determine rational approaches to bronchobiopsy for the purpose of differential diagnosis of TB, mycobacteriosis and neoplasia.

Conclusions. The use of EGI of PPLs assessment during bronchoscopy with rEBUS navigation determines rational approaches to the complex of navigational bronchobiopsies in the differential diagnosis of TB, mycobacteriosis and malignant processes.

External genital endometriosis (EGE) is a common disease that substantially lowers quality of life in women. EGE is accompanied by chronic pelvic pain in 50% of cases. The role of the hemostatic system, proinflammatory factors, the complement system, and other biomarkers in the pathogenesis of EGE seems interesting. The literature describes an endometriosis-characteristic (local and systemic) condition of local and systemic hypercoagulation, activation of proinflammatory molecules, chemokines, and complement components. It is remarkable that after surgical removal of endometrioid foci, the biochemical and coagulation parameters return to normal. The objective of this review is to summarize the data on the diagnostic and prognostic significance of hemostatic factors, proinflammatory cytokines, cancer markers, the immunological and genetic panels within the framework of EGE.

Treatment of arterial hypotension is a complex problem that requires correction of the hemodynamic parameters of the patient and, if possible, an impact on the cause of a decrease in blood pressure. It is necessary to pay attention to the correction of factors aggravating the course of hypotension. It is also important to use non-drug methods of correction of low blood pressure, such as wearing compression underwear, increasing fluid and salt intake, the use of physical maneuvers and exercises. Pharmacological therapy of hypotension includes the use of a number of drugs with different mechanisms of action, such as midodrine, fludcortisone, droxidopa, norepinephrine membrane transporter inhibitors. Special attention is paid to the treatment of orthostatic hypotension, postprandial hypotension.

The article deals with modern clinical and pathogenetic features of the variants of the respiratory pattern of non-invasive lung ventilation with two phases of airway pressure in the neonatal intensive care unit. The epidemiology, pathogenesis and assessment of the severity of the clinical picture of the neonatal respiratory distress syndrome are presented. The anatomical and physiological features of cardiorespiratory adaptation and targeted indicators of complex monitoring of the vital functions of the body of premature babies during the initiation of the starting two-phase non-invasive ventilation of the lungs are discussed. Early predictors of failure and criteria for optimizing the clinical efficacy of initial biphasic non-invasive ventilation in children with extremely low birth weight are considered. The clinical and prognostic role and features of perinatal screening were assessed when choosing the tactics of starting respiratory support in premature infants in the neonatal intensive care unit.

When supervising patients, a practicing physician daily faces various clinical and laboratory syndromes. To make a differential diagnosis for many conditions and diseases, the physician must have not only practical experience, but also a broad outlook, including in a number of related specialties. The pathomorphism of diseases, the atypical clinical presentation at the onset of the disease increasingly require the involvement of a multidisciplinary team to solve diagnostic puzzles. The presented clinical case considers the stages of inpatient diagnostic search in a patient with generalized lymphadenopathy. Exclusion of lymphoproliferative diseases became possible only after lymph node excision biopsy, by making an immunohistochemical study, bone marrow puncture, and trepanobiopsy. The nephrotic syndrome and the thyrotoxicosis syndrome have become the following stage of a differential diagnosis.

A review of data on the main types of primary headaches in adolescents – tension-type headache (THT) and migraine (Mi) – was carried out. Definitions and characteristics of these types of cephalgia are given. The results of our own study are included, which showed differences in the frequency of occurrence and clinical features of these types of pathology in adolescents of different age and sex groups, their association with the type of online behavior and their closer relationship with non-adaptive and pathological (Internet-dependent) behavior of adolescents. Of the 5,195 adolescents surveyed, 51.9% were characterized by adaptive online use (AIU), 40.6% non-adaptive (NIU) and 7.5% 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 primary cephalalgia associated with maladaptive types of online behavior (NIU and РIU).

Celiac disease is a genetically determined disease with its onset in childhood.

In November 2021, a 51-year-old female patient was admitted to the Gastroenterology Department with complaints with diarrhea 5 times daily and severe protein-energy malnutrition by the type of senile kwashiorkor. Analysis of her history indicated that in March 2021, the patient took amoxicilline 500 mg twice daily, as prescribed by the local therapist, for 2 weeks, whereupon she noted the appearance of diarrhea that lasted for a month. Moreover, antibiotic-associated diarrhea was ruled out. A celiac-disease-specific histological pattern of the small bowel mucosa was revealed (the ratio of villus height to crypt depth was 1:1), as well as the titer of antibodies to recombinant tissue transglutaminase-2 IgA class >210 U/ml. This could establish a diagnosis of symptomatic celiac disease. During the gluten-free diet, the stool returned to normal; the body weight gradually began to increase. The persistent severe condition in the patient, hypokalemia, skin bronze hue, low aldosterone levels could diagnose primary hypoaldosteronism. Liver biopsy could diagnose small duct primary sclerosing cholangitis. Thus, it is important to note that the onset of celiac disease may occur may occur in people over 50 years of age; whereas primary hypoaldosteronism and primary sclerosing cholangitis may be associated with celiac disease and have a common autoimmune origin.

There are more and more studies that focus on cognitive decline in patients with chronic obstructive pulmonary disease (COPD). Obstructive sleep apnea syndrome (OSAS) is characterized by a repetitive cessation or decrease in airflow due to upper airway obstruction. Chronic sleep disturbance and intermittent hypoxemia lead to neurocognitive changes. Patients with comorbidity of COPD and OSAS may develop more severe nocturnal hypoxia than those with OSAS or COPD alone. At the same time, cognitive dysfunction in elderly patients with comorbidity of OSA and COPD has not been previously studied.

Objective. The study the effects of OSAS on cognitive impairment and quality of life in elderly patients with COPD.

Materials and methods. We examined 84 patients with COPD of moderate severity, controlled course at the age of 60–74 years (mean age – 66.3±4.1 years), of which the first group consisted of 43 patients with COPD, the second group – 41 patients with COPD and OSA of moderate severity.

Results. Patients with COPD and moderate OSA had worse MMSE and EQ-5D-3L scores compared to patients with COPD alone, and were more likely to have dementia on the MMSE scale (MMSE≤24 scores), which may require an individual approach to the treatment of such patients.

Objective. To analyze the literature, which reflect the results of the study of the pharmacological properties of hawthorn blood-red and the possibility of using the above-ground part of the plant in the Russian drug Cardioton in patients with cardiovascular disease.

Material and methods. An analysis was made of more than thirty scientific publications of Russian and foreign researchers, reflecting the use of blood-red hawthorn, as well as rose hips and royal jelly, which are components of the drug Cardioton, in patients with cardiovascular diseases.

Results. The hawthorn-blood-red preparations have cardiotonic, coronary dilation, hypotensive, antiarrhythmic, antispasmodic and antioxidant effects. The drug Cardioton combines in its composition whole above-ground parts of hawthorn-blood-red - fruits, flowers and leaves.

Conclusions. Use hawthorn-blood-red is associated with improvement in the general well-being of patients. The drug Cardiotone, produced by the Russian company "Parafarm" has antioxidant, cardioprotective, hypotensive, hypocholesterolemic, anti-inflammatory, metabolic effect and can be recommended for the complex prevention and treatment of cardiovascular diseases.

Objective. To find the relationship between the quantitative indicators of DNA TREC and KREC with three groups of pathological conditions: sudden death syndrome, frequent diseases of the bronchopulmonary system and allergic diseases.

Materials and methods. The study was conducted retrospectively. The survey group included infants and young children with various diseases, in which, based on the anamnesis, the presence of a pathology of the immune system was assumed. A total of 43 children were examined, of which group I - 5 children with sudden death syndrome, group II - 25 patients with frequent diseases of the bronchopulmonary system who received long-term antibiotic therapy, group III - 13 children with allergic diseases. Quantitative determination of TREC and KREC was carried out from samples of "dry spots" of blood obtained during neonatal screening.

Results. Low TREC values were recorded more frequently than low KREC values, found in 79.1% and 48.8%, respectively. In the group of patients with sudden death syndrome (I group), who died in the first - fourth months of life, there were high rates of intrauterine growth retardation, dysembryogenesis stigma, congenital malformations, intrauterine infections. This group of children is characterized by thymomegaly and hypoplasia of the adrenal glands, TREC and KREC values are reduced in all children. The group of children with a high frequency of bronchopulmonary diseases (Group II) is characterized by a persistent course of herpes virus infection, prolonged subfebrile condition, neutropenia, transient hypoimmunoglobulinemia A, and thymomegaly. Low TREC values were found in 88% of children of group II, KREC - in 32%. In the III group of patients with allergic diseases (bronchial asthma, atopic dermatitis, allergic rhinitis, food allergy), TREC values are reduced in 53.8% of children, KREC – in 61.5% of children. Children of this group often suffered ARI, laryngotracheitis, obstructive bronchitis. During the first months of life, 75% of children manifested atopic dermatitis. In 62.5% of children with allergic diseases, a low level of serum immunoglobulin A was detected.

Conclusions. Low values of TREC and KREC in a significant part of the examined patients make it possible to suspect the pathology of the immune system. The presence of diseases belonging to the group of warnings for the presence of primary immunodeficiency may also indicate the pathology of the immune system, primary or transient, due to infections, prematurity, intrauterine growth retardation, toxic effects. Comparison of the results of the survey in the neonatal period and diseases formed in infancy and early childhood was carried out retrospectively. The introduction in the Russian Federation of neonatal screening of primary immunodeficiencies based on the quantitative determination of TREC and KREC makes it possible to timely diagnose immunity errors and prescribe modern methods of treatment. However, the cut-off of the TREC and KREC values needs to be revised in the future.

The use of artificial intelligence (AI) in dentistry is a promising field that has the potential to revolutionize the healthcare sector and improve the quality of dental care. Researchers are also discussing methods of telemedicine health screening, including the use of questionnaires and AI to analyze the data obtained. AI can be used to automatically analyze X-rays and detect dental and gum disease, such as cavities, periodontitis and others. AI can help determine the best therapy and medication dosage for each patient based on his or her individual characteristics. Moreover, AI can be used to plan surgical procedures, such as dental implants. Also, current techniques include the use of telemedicine for online consultations, diagnosis, and treatment of dental and gum disease.

For the purposes of this review, we will limit ourselves to a brief list of digital advances in caries diagnosis and prognosis.