Vol 34, No 11 (2023)

The study of the features of the relationship between the mental state of the patient and skin pathological processes at the present stage is especially relevant. This is due not only to an increase in the prevalence of psycho-dermatological comorbidity, but also to the pathogenetic features of the formation of the clinical picture of this pathology, which make it difficult to diagnose. Skin lesions can either be a consequence of a primary psychiatric illness or induce the development of concomitant psychosocial illnesses. At the same time, mental disorders masked by skin manifestations combine, as a rule, skin lesions due to self-harm. Their clinical picture can mimic the symptoms of a number of nosologies, including not only dermatological pathology, but also systemic diseases with skin manifestations. The artificiality of rashes may not always be obvious, which often leads to the erroneous involvement of doctors of various specialties in the diagnostic search and prolongs the time for making the correct diagnosis.

The article presents our own clinical observations of patients with autodestructive dermatosis, in which the verification of the diagnosis was accompanied by diagnostic errors, which caused pronounced destructive changes. In the analysis of the above clinical observations, attention is focused on the features of the skin pathological process, aspects of differential diagnosis, as well as insufficient awareness of primary health care professionals about this problem. Increased awareness of doctors of related specialties can contribute to clinical alertness, reduce the time of diagnosis and timely start of therapy for these patients by a psychiatrist, which will reduce the risk of an increase in the severity of the disease and social exclusion of patients.

Asthma diagnostics especially of it’s mild forms, is considered to be a serious problem within primary health care unit due to the absence of exact evaluation algorithm of subjective, clinical and functional manifestations.

Objective. The goal of our study was to create recommendation on early asthma diagnostics in childbearing aged females, based on particular analysis of complaints, clinical and functional test results and to make them available to all primary medical care units.

Materials and methods. 2460 females of childbearing age with various severity of asthma duration were studied with complex of clinic and functional methods.

Results. Patients with various grades of asthma severity could be compliant free, same time the can appear signs of bronchial obstruction during auscultation. The marked discordance leads to mismatch in therapy administration. PEF₅₀ decrease while initial spirometry and its’ increase after probe with bronchodilator is considered to be the earliest sign of bronchial obstruction. Asthma diagnostics at prehospital stage is to based upon complete chart collection, complaints analysis, auscultation signs while forced expiration as well as on spirography data on volume and forced expiration dynamics and PEF₅₀.

Conclusion. Results of large population study on clinical feature of asthma duration and functional diagnostics of mild asthma duration could be recommended for primary health care physicians as method of early asthma diagnostics and therapy administration.

Objective. Study the reaction of the white pulp of the spleen of laboratory mice in an experiment on parenteral administration of human pharmacy albumin.

Materials and methods. Nine 30-day-old mice were divided into three groups of three mice each (intact and two experimental). Experimental mice were intraperitoneally injected with a human albumin pharmacy drug at a dose of 0.9 ml every other day for 30 days. The animals of the intact and first experimental groups were removed from the experiment by decapitation on the 30th day from the beginning of the experiment, the second experimental group – 1 month after the last injection (60 days from the beginning of the experiment).

Results. Albumin increased the wet mass of the spleen from 0.74±0.01 g (control) to 1.40±0.02 and 1.20±0.04 g in groups 1 and 2, respectively; induced amyloidosis, determined by the relative area of the congophilic substance in 4 microns of paraffin sections of the spleen – 13.32±1.31 and 23.47±0.84% in groups 1 and 2, respectively; reduced the average area of lymphoid nodules from 1.34±0.10•10⁵ mkm² (control) to 1.18±0.08•10⁵ and 0.91±0.04•10⁵ mkm² in groups 1 and 2, respectively; increased the relative area of white pulp – from 22.65±2.30% (control) to 34.99±2.34 and 31.87±1.68% in groups 1 and 2, respectively, and reduced the relative area of the red pulp – from 77.35±4.20% (control) to 65.01±2.34 and 68.13±1.68% in groups 1 and 2, respectively, which led to a significant decrease in the index (red pulp) / (white pulp) from 6.67±1.39 (control) to 2.79±0.42 and 2.65±0.29 in groups 1 and 2, respectively. In all cases, the differences are statistically significant.

Conclusions. Parenteral administration of human albumin to mice at a dose of 0.9 ml of a pharmacy drug causes amyloid damage to the spleen. Discontinuation of the introduction of amyloidogen protein does not prevent the development of the amyloid process that has begun.

Objective. To determine the functional state of right cardiac chambers in patients with asthma of varying severity according to Doppler echocardiography.

Subjects and methods. Cardiopulmonary hemodynamics was assessed in 56 asthmatic patients, by using ultrasound. The examinees were divided into 3 groups by the severity of the disease.

Results. With an increase in the severity of asthma, diastolic dysfunction of the right ventricle (RV) progressed with the development of its dysfunction that further plays a dominant role in developing chronic heart failure. As diastolic dysfunction of the RV progressed in the asthmatic patients, there was an increase in the contractile activity of the right atrium (RA) simultaneously with a decrease in the Е/А ratio.

Conclusion. In asthmatic patients, diastolic dysfunction in the right cardiac chambers frequently precedes systolic dysfunction, which manifests itself in a change in the ratio of various phases of RV filling. During RV diastolic dysfunction, there is a relative increase in the contractility of RA.

Coronavirus infection brings an extreme threat to older people and particularly to patients with severe cardiovascular pathology, including coronary heart disease (CHD). Recovery in these patients largely depends on the severity of cytokine disorders in the acute phase of the disease, since they negatively affect cardiomyocytes, including those through the development of complications in other organs and systems. However, changes in the plasma cytokines of elderly patients with CHD who have experienced COVID-19 have not been studied in practice.

Objective. To study the correlations of plasma cytokines in older patients with CHD in the early recovery stages after COVID-19.

Subjects and methods. The investigation enrolled 40 elderly patients with CHD at weeks 3-4 following recovery from COVID-19 and 38 patients of the same age with CHD without COVID-19 in their history. The fasting plasma cytokine level was determined using a Becton Dickinson FACS Canto 2 apparatus (USA) in the morning. The relations between the cytokines were studied by the correlation method.

Results. Interleukin (IL)-6 showed the greatest number of significant correlations (direct weak and medium associations with other cytokines), including a direct statistically significant average correlation with IL-17 (r=0.63), tumor necrosis factor-α (TNF-α) (r=0.42), interferon-γ (IFN-γ) (r=0.39), IL-2 (r=0.35), IL-3 (r=0.33), as well as a weak significant relationship to IL-7 (r=0.29). IFN-γ had three direct significant correlations with IL-6 (r=0.39), IL-7 (r=0.36), and TNF-α (r=0.29). The latter showed two direct average significant correlations with IL-6 and IL-17.

Conclusion. In the early stages of recovery, in 60–74-year old patients with CHD after experienced COVID-19, IL-6, IFN-γ, and TNF-α cytokines had the greatest conjugacy, which can be used as markers of recovery in this patient cohort.

The incidence of cardiovascular diseases associated with the treatment of malignancies varies widely depending on the antitumor therapy, its duration, and concomitant diseases of a patient.

Objective. To assess comorbid pathology in patients with breast cancer (BC).

Material and methods. The study included 100 women with breast cancer aged 30 to 80 years. The patients were divided into 5 groups according to their age. The following were assessed: primary and concomitant diseases, history of the primary disease, results of instrumental methods of investigation – ECG, chemotherapy, radiotherapy, and metabolic therapy. The Charlson comorbidity index was calculated, and the one-year death risk and 10-year survival rate in patients with BC were assessed.

Results. The following comorbid pathologies were the most common in the study group patients: hypertension, angina pectoris, chronic gastritis, and myocardiodystrophy. Increasing prevalence of comorbid pathology, significant growth of Charlson comorbidity index score, and deterioration of prognostic indexes were revealed in patients older than 40.

Conclusion. In patients with BC aged 40 and older, cardiovascular pathology, particularly hypertension, angina pectoris, myocardiodystrophy, prevails in the comorbidity structure. Patients most often had a combination of cancer with two or more comorbidities. A significant increase in the Charlson comorbidity index score was observed with age in all patients with BC. According to the prognostic value of the Charlson comorbidity index, 56% of the studied patients with BC have a high risk of one-year mortality and a low 10-year survival rate.

This clinical case reflects a variety of symptoms in obesity with central nervous system involvement. At the same time, the use of liraglutide in an obese patient resulted not only in the reduction of visceral fat area, but also in the improvement of cognitive functions, reduction of neuropilin, and as a consequence, reversibility of neurometabolism and functional changes in the brain. Literature sources from international and Russian databases for 5 years were used to compare the results.

The article provides epidemiology, main international recommendations and domestic clinical experience of the early use of the Silverman–Andersen respiratory scale in the comprehensive assessment of neonatal respiratory distress syndrome (NRDS). The modern anatomical and histological prerequisites and clinical and pathophysiological features of respiratory failure, pathognomonic for the development of NRDS in the early neonatal period, are considered. The important clinical and prognostic role of the initial use of the Silverman–Andersen scale in assessing the development/progression of NRDS in premature infants of small gestational age with the targeted choice of starting non-invasive ventilation in the conditions of the neonatal intensive care unit of the maternity hospital of the perinatal center of the S.S. Yudin City Clinical Hospital (Moscow).

Today, natural and preformed physical factors occupy a special place in medical rehabilitation. For many years, a large number of experimental and clinical studies have been carried out, including dissertations, which have proved the high effectiveness of the use of the above factors in the treatment of patients with various diseases.

Objective. To review dissertations that are devoted to the study of the effect of the complex application of physical factors in patients with diseases of the musculoskeletal system, neurological, and urological diseases for the period 2000–2020.

Materials and methods. We have analyzed publications in the disserCat scientific electronic library of dissertations and abstracts over the past 20 years, which are devoted to the study of the use of complex physiotherapy in the medical rehabilitation of patients with diseases of the musculoskeletal system, neurological and urological diseases.

Conclusion. Currently, there is a fairly serious evidence base confirming the effectiveness of complex physiotherapy in the medical rehabilitation of patients with diseases of the musculoskeletal system, neurological and urological profile.