Vol 34, No 6 (2023)

Objective. To assess the trend and variability of standardized mortality ratios (SMRs) from chronic forms of coronary heart disease (CHD) in the regions of the Russian Federation (RF) in 2017–2021.

Material and methods. The investigation used the 2017–21 Russian Federal State Statistics Service (RFSS) data on the average annual population and the number of deaths in the one-year age groups in 82 RF regions on the basis of the RFSS “Brief Death Cause Nomenclature” (BDCN). The SMRs were calculated on the basis of the European standard per 100,000 population for each region; then the average regional SMRs related to the chronic forms of CHD were determined using 4 BDCN accounting lines.

Results. For the period from 2017 to 2019, a decrease was noted in the average regional SMRs from all forms of CHD (from 183.9±68.5 to 176.8±65.3 cases per 100,000 population), but in 2020 and 2021, an increase was recorded in SMRs from CHD (204.3±75.4 and 207.4±76.9 cases per 100,000 population, respectively) as the proportion of these causes decreased in the structure of all-cause mortality in the COVID-19 pandemic period (18.4±7.1% in 2017 and 15.8±5.4% in 2021). there was a decrease in the average regional SMRs from all forms of chronic heart diseases (CHD) (from 183.9±68.5 to 176.8±65.3 cases per 100,000 population), but in 2020 and 2021, an increase in the SMRs from CCHD (204.3±75.4 and 207.4±76.9 cases per 100,000 population, respectively) hand in hand with a reduction in the proportion of these causes in the COVID-19 pandemic period (18.4±7.1% in 2017 and 15.8±5.4% in 2021).

Results. For the period from 2017 to 2019, over a 5-year period, an annual consistent decrease was recorded in the SMR from CHD in none Russia’s regions; their annual rise was seen in 4 regions; whereas an unstable trend was noted with a decrease and a rise in SMRs in the others. There was a considerable interregional variability of SMRs from all forms of CHD (in 2017, the maximal SMR differed from the minimal one by 60 times) and from individual forms of CHD (in 2020, the regional minimum and maximum SMRs from I25.1 differed by 500 times).

The paper presents hypotheses about the causes of the revealed differences and proposals to modify the accounting of deaths from CHD.

Conclusion. There were substantial regional differences with an unstable 5-year trend in SMRs from CHD in the entire and individual accounting forms included in this group in accordance with the ICD. The fact that there are no unified criteria for and approaches to identifying the individual forms of CHD as the main cause of death, including that in the presence of multimorbid pathology complicates understanding the causes of death.

The endothelium is a fully valid organ that is involved in the regulation of many processes in the body. A huge number of both internal and external environmental factors influence the function of endothelial tissue, which makes the study of its dysfunction an urgent medical problem. As of now, it has been proven that carbohydrate imbalance is of paramount importance in the biochemical processes regulated by the endothelium, whereas the COVID-19 pandemic has shown the need for a more detailed study of the impact of endothelial dysfunction on the body. The paper reviews the literature on studying the mechanisms of endothelial dysfunction in carbohydrate imbalance and compares the clinical and morphological indicators in patients who have and do not have a history of type 2 diabetes mellitus and COVID-19.

A review of data on the main types of primary cephalgia in adolescents (headache tension and migraine), their prevalence, classification, clinical manifestations, basic principles of treatment and prevention is presented. The results of our own study, which showed a closer relationship between the frequency of occurrence and clinical features of these types of pathology with the presence of addiction to computer games and social networks in adolescents, are included. Of the 5195 surveyed adolescents, 8.1% had an to social media addiction, 10.5% had a Gaming Addiction, including 7.7% moderate and 2.8% severe. The authors come to the conclusion that it is necessary to analyze the characteristics of Internet use and content consumed by adolescents for early diagnosis, treatment and prevention of primary cephalalgia associated with the presence of gaming addiction and dependence on social networks, highlight approaches to the treatment of migraine in adolescents.

Objective. To evaluate the efficiency and safety of therapy with parenteral chondroitin sulfate (CS) Chondroguard^®, CS-Bioactive^© (Bioiberica S.A.U., Spain); ZAO “Sotex” PharmFirm, Russia) in patients with Stage II knee osteoarthritis (KOA), grade 1 knee functional insufficiency (FI), and type 2 diabetes mellitus (T2DM).

Subjects and methods. A 50-day comparative pilot study involved 80 patients with Kellgren-Lawrence Stage II KOA, grade 1 FI, and T2DM, who were divided into 2 groups; Group 1 (a study group; n=40) received CS (Chondroguard^®, 100 mg/ml, intramuscularly, every other day; the first three injections of 1 ml each; if they were well tolerated; starting from injection 4 of ml each; the treatment cycle was 25 injections for 50 days) and therapy for T2DM and its complications; Group 2 (a comparison group; n=40) took oral symptomatic slow acting drugs for osteoarthritis (SYSADOA) agents containing CS, glucosamine, unsaponifiable compounds of avocado and soybean, and therapy for T2DM and its complications. On study days 0 and 50, the investigators calculated in the patients the scores of the visual analogue scale (VAS), WOMAC index, the Lequesne index, those of the WHO and the Narango Therapy Safety Scales, assessed the parameters of the blood hormonal and metabolic profile, free radical oxidation (FRO), antioxidant system (AOS), and the levels of blood proinflammatory factors.

Results. In Group 1, therapy with CS was well tolerated and was accompanied by a reduction in pain intensity on VAS at rest and in motion, in functional restrictions on the WOMAS index and the Lequesne index, as well аs by a decrease in blood proinflammatory markers (С-reactive protein, interleukin 6 and 1β, leptin, lipocalin-2), in the concentration of fasting and postprandial glucose, HbA1c, С-peptide, insulin-like growth factor-1, and in FRO-AOS activity (malondialdehyde, protein oxidative modification, superoxide dismutase) as compared with the indicators in Group 2.

Conclusion. Chondroguard^® was shown to be effective and safe in the combination therapy in patients with Stage II endocrine KOA phenotype, grade 1 FI, and T2DM.

Objective. Determination of the place of flavonoids quercetin and dihydroquercetin as a preventive and auxiliary agent in the treatment of cardiovascular diseases.

Material and methods. The analysis of literature data was carried out, in which the results of studies on the use of flavonoids quercetin, dihydroquercetin (taxifolin) in animal experiments and in patients with cardiovascular diseases were presented, as well as data from experimental laboratory studies were analyzed.

Results and discussion. Flavonoids had antioxidant, antiradical, vasoprotective, antiplatelet, anti-inflammatory effects. They slow down the development of atherosclerosis and cardiovascular diseases, and are also a means of preventing fatal cardiovascular complications. The antihypertensive, anti-ischemic, antiarrhythmic, hypolipidemic, antiplatelet effect of quercetin and dihydroquercetin has been shown. The possibility of using dihydroquercetin in the complex treatment of patients with arterial hypertension is shown. The high efficiency of the drug Bio Dihydroquercetin, which is distinguished by a special author's production technology, and is a highly active dihydroquercetin, of natural origin with proven efficacy and safety, was noted. Taking dihydroquercetin is associated with a decrease in blood viscosity, a decrease in aggregation, an improvement in the deformability of red blood cells, as well as an improvement in endothelial function and tissue perfusion.

Conclusions. Flavonoids quercetin, dihydroquercetin (Dihydroquercetin) have antioxidant, vasodilator, hypotensive, antiplatelet, hypolipidemic, anti-ischemic, anti-inflammatory effects. They can be used in the comprehensive prevention and treatment of patients with cardiovascular diseases.

Recent studies have been focused on studying new relationships that demonstrate associations of non-conventional risk factors for cardiovascular diseases in female populations, not only from the standpoint of a possible reduction in cardiovascular risks, but also the search for new technologies for preventive intervention, involving the study of the influence of parameters that reflect the attitude of the population to health, prevention and medical care. At the same time, the number of such studies at the population level, especially on the territory of the Russian Federation, is currently rare. However, their demand due to the consistently high levels of cardiovascular morbidity and mortality in the world and in Russia is obvious and is positioned by leading cardiologists and epidemiologists.

The early diagnosis of rheumatoid arthritis (RA), the assessment of the severity of its course, and the early prediction of destructive changes are the key to adequate and effective therapy. The modern principles of RA treatment are based on early aggressive therapy at the onset of the disease (the window of opportunity” concept), which allows a sustained remission to be achieved in a number of cases. Lung damage is one of the most common extraarticular manifestations in RA. Lung lesion in the early-stage RA includes respiratory tract damage. Perhaps, the lung should be considered as a place of initiation of the pathological process in RA.

The paper gives the results of the study assessing the data of high-resolution tomography of the lung in patients with early RA.

In recent years, the situation on the main epidemiological indicators of tuberculosis (TB) in the Russian Federation has clear positive changes, including those among the pediatric population. The criterion of the efficiency of the therapy performed and the quality of a follow-up after completing the basic therapy cycle is the absence of a relapse of the disease and hence the chronization of the process. It is commonly supposed that the appearance of the signs of active TB in individuals who have experienced and cured of TB is a relapse of TB. The paper describes the clinical case of recurrent TB, which shows that the main risk factor for primary TB is the lack of immunization against TB due the perinatal contact of a child with a HIV-infected mother. The provoking factor for a relapse was exogenous TB superinfection due to the development of new cases of the disease in the family in the presence of a child’s long-term already existing contact.

This article examines the causal relationship between gastroesophageal reflux disease (GERD) and atrial fibrillation (AF). The problems of treatment of this comorbid pathology are highlighted. In some studies, antireflux therapy for GERD demonstrates effective antiarrhythmic activity against AF, in others it indicates the possible development of the opposite - a proarrhythmic effect. Treatment of AF with catheter ablation can exacerbate GERD and cause severe complications. The obtained results indicate that large prospective studies are required for a more detailed understanding of the features of the interaction between GERD and AF, as well as the tactics of managing patients with this comorbid pathology.

One of the most common human diseases is acute cystitis, which affects mainly women. Annually in Russia there are 26-36 million cases of acute cystitis. The most severe contingent is considered to be patients with acute complicated cystitis, whose treatment efficiency is only 64.6–85.8% or less.

Objective. Evaluation of the analgesic effect, efficacy and tolerability of phenazopyridine in combination with the antibiotic cefixime for the treatment of acute complicated cystitis in women of working age.

Material and methods. A multicenter randomized open study of phenazopyridine in combination with the antibiotic cefixime in the treatment of 144 women with an average age of 42.2±3.8 years with acute complicated cystitis was performed in 5 polyclinics of the Perm region. In 55.6% of patients, the risk factors were not urological, but therapeutic and gynecological diseases. The international scale of cystitis ACSS, visual analogue scale (VAS) of pain, laboratory and bacteriological methods were used. The main group consisted of 72 women who received oral phenazopyridine (Urinalgin F) at a dose of 200 mg 3 times a day for 2 days and cefixime 400 mg 1 time per day for 7 days. The comparison group consisted of 72 women who received orally cefixime at the same dose for 7 days and No-spa (drotaverine hydrochloride) 80 mg 3 times a day for 2 days.

Results. In the main group, a strong analgesic and antidysuric effect of phenazopyridine was noticed, which was confirmed by the analysis of the ACSS and VAS scales. Already after 20 minutes, an analgesic effect was detected, after 2 days pain symptoms and dysuria completely disappeared in 70 (97.2%) patients, despite the high initial level. The pain index on the VAS scale decreased from the initial 6.5 points to 0.03 points, i.e. by 217 times.

The clinical efficacy (recovery) of combination therapy with phenazopyridine and cefixime was 91.7%, bacteriological efficacy was 91.8%, leukocyturia disappeared earlier, and the period of temporary disability decreased by 28.6%. In the comparison group, clinical (83.3%) and bacteriological (83.6%) efficiency was lower. Urinalgin F showed a favorable safety profile, only 1 (1.4%) patient had a side effect (nausea).

Conclusion. Phenazopyridine (Urinalgin F) is a drug with high effectiveness and tolerability that eliminates pain, dysuria and other symptoms of acute complicated cystitis, eliminates leukocyturia earlier and more significantly, and reduces the period of temporary disability by 28.6%. Combined therapy of acute complicated cystitis with the antibiotic cefixime and the selective analgesic Urinalgin F has a high clinical and bacteriological efficacy.

The paper considers the possibilities of therapy for secondary systemic osteoporosis in rheumatoid polyarthritis, by using Osteomed and Osteo-Vit D3, which contain drone brood homogenate in combination with vitamin D3 vitamin В6, calcium, and other trace elements.

Artificial Intelligence (AI) has been making significant strides in various fields, including healthcare. One such area is dental implantology. AI can assist in accurate diagnosis, treatment planning, in the execution of the procedure, and predict implant success based on various factors like bone density, implant site, patient's medical history, etc.

Despite the promising potential, the application of AI in dental implantology is still in its nascent stages. Research in this area of medicine is limited, but there has been an increase in recent years. This trend is related to the possibility of improving patient outcomes, including shorter treatment times, prevention of complications and improved quality of care in general.